Purpose The SHoT study was set up as a national student health survey for higher education in Norway, conducted at 4-year intervals. The dataset comprises a wide range of self-reported data covering information on mental and physical health, quality of life, health-related behaviours as well as more specific study-related information.
Participants The SHoT studies conducted so far in 2010, 2014 and 2018, included 6053, 13 525 and 50 054 fulltime students (aged 18–35), respectively.
Findings to date The main results from the first two waves have been published in three comprehensive Norwegian reports, with the most important finding being an increase in mental health problems (HSCL-score ≥2.0) among Norwegian college students from 2010 (16%) to 2014 (21%) to 2018 (29%).
Future plans The next SHoT study will be conducted in 2022, 2026 and so on. Starting from 2018-study, the survey data can also be linked to several national registers.
- mental health
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Strengths and limitations of this study
The SHoT study is a national student health survey for higher education in Norway, conducted at 4-year intervals.
The SHoT studies conducted so far in 2010, 2014 and 2018, included 6053, 13 525 and 50 054 fulltime students (aged 18–35), respectively.
The dataset comprises a wide range of self-reported data covering information on mental and physical health, quality of life, health-related behaviours as well as more specific study-related information.
The SHoT2018, and future waves, allow the data to be linked to several national registers.
A limitation is the relatively low response rate for both the SHoT2010 (23%), SHoT2014 (29%) and SHoT2018 (31%).
Epidemiological studies suggest that 12%–50% of college students meet criteria for one or more common mental disorders,1–3 and mental disorders in this age group are associated with long-term adverse outcomes, including persistent emotional and physical health problems4 and labour market marginalisation.5 6 Mental health problems are also directly associated with lower academic performance, which in turn, is associated with dropout in the short-term and loss of human capital for societies in the longer term.7 As such, mental health problems in college students constitute both a clinical, educational problem and societal problem.
Still, there are few large epidemiological studies on the prevalence of mental health problems in college students, despite being a crucial transitional period making in particularly important to study. First, most mental disorders have an onset in late adolescence and early adulthood.8 Second, the proportion of young adults now attending higher education has increased steadily in recent decades. In 2015, close to half of the Norwegian adult population (aged 25–64 years) had completed higher education, and the number is growing.9 In a Canadian study, less than 40% of 18–24 year olds who were depressed had spoken to a health profession about their mental health in the last 12 months.10 As such, detecting mental health problems among college students provides excellent opportunities for addressing the substantial burden of early-onset mental problems. In addition, identifying this population at an early stage in their adult life has several important benefits, given the substantial consequences that mental health problems have on subsequent educational, social and economic outcomes.
The SHoT study (an acronym for the Norwegian name: Studentenes Helse- og Trivselsundersøkelse [Students’ Health and Wellbeing Study]) is a national student survey for higher education in Norway. So far, three health surveys of the student population in Norway have been completed (2010, 2014 and 2018). Both the size and scope of the SHoT studies have expanded over time, and now includes detailed information on mental and physical health, quality of life, health-related behaviours, demographics and more specific study-related information. The background for the first survey was that there existed limited data on these topics in the student population. Although some data had been collected locally at campuses from small surveys before 2010, no systematic surveys had been conducted yielding more comprehensive knowledge. On this backdrop, the three largest student associations in Norway assembled to set up a national survey to be repeated every 4 years, with the ambition to build a representative knowledge base on student health.
The main scientific aim of the SHoT study is twofold: (1) to examine prevalence and trends across a range of health problems and life challenges among college and university students and (2) to examine both predictive factors all the way from birth through adolescence as well as to investigate important outcomes in terms of subsequent health, educational success and work situation, by linking the SHoT2018 survey to several high quality national registries.
Norway is a Northern European country characterised as a social democratic welfare state, with generous universal public health insurance coverage, and predominately public health services. Higher education in Norway is offered by 8 universities, 9 specialised universities, 24 university colleges and several private university colleges. Public education is free, with an academic year with two semesters, from August to December and from January to June. All students belong to a student welfare association that takes care of such services as housing, kindergartens, advisory services and some healthcare.
The SHoT2010 study
The SHoT2010 was conducted by TNS Gallup on behalf of the student societies in Oslo, Bergen and Trondheim, and with additional participation from Stavanger, Oppland, Telemark and Finnmark. The data collection internet-based and was conducted during the period 11 October to 8 November 2010. The target group was Norwegian full-time students<35 years of age. A total of 6053 students completed the survey, yielding a response rate of 23%. At the time, this was the most comprehensive survey conducted on students' health and well-being in Norway.
The SHoT2014 study
The SHoT2014 study was a collaboration between the 10 largest student welfare associations in Norway (Oslo, Bergen and Trondheim), targeting full-time Norwegian students<35 years of age. Data for the SHoT study were collected using an internet platform in the period from 24 February 2014 to 27 March 2014. An invitation email containing a link to an anonymous online questionnaire was sent to 47 514 randomly selected students and stratified by study institutions, faculties and departments. The overall response rate was 28.5% and included all 13 525 students with valid response on the sleep questionnaire. Written informed consent was obtained from all participants prior to data collection. Approval for conducting the SHoT study was granted by the Data Protection Officer for research at the Norwegian Social Science Data Services, as ombudsman for Inspectorate.
The SHoT2018 study
The SHoT2018 study was a joint effort between the Norwegian Institute of Public Health (NIPH) and all student welfare associations in Norway. The study was conducted between 6 February and 5 April 2018 on all fulltime Norwegian students taking higher education (both in Norway and abroad). The collection of the health survey was in close collaboration with all the student welfare associations in the Norway, and several institutions allocated 45 min in student classes allowing for sufficient time for the students to complete the set of questionnaires. The survey data were collected electronically through a web-based platform. In all 162 512 students fulfilled the inclusion criteria, of whom 50 054 students completed the online questionnaires, yielding a response rate of 31%.
Representativeness of the SHoT2018
Compared with all invited students (58.1% women (n=93 267) and 41.9% men (n=67 558)), the SHoT2018 sample included a larger proportion of women (69.1%) than men (30.9%). The mean age was 23.2 years (SD=3.3), and the age distribution of participating students (18–20 years (18%, n=8832), 21–22 years (31%, n=15 471), 23–25 years (32%, n=15 902), 26–28 years (12%, n=5710) and 29–35 years (7%, n=3427)), was almost identical to that of all invited students (18–20 years (18%, n=28 996), 21–22 years (31%, n=49 731), 23–25 years (32%, n=51 714), 26–28 years (12%, n=19 901) and 29–35 years (7%, n=10 216)). As response rates are particularly important in prevalence studies, care should be taken when generalising the current findings to the whole student population. Rather, it may be more appropriate to explore associations/correlations and to emphasise the relative differences between men and women as well as different age cohorts, as these estimates are less prone to selection bias.
An overview of the main included instruments/variables in the three SHoT studies is presented in table 1, covering self-reported information on both mental and physical health, quality of life, health-related behaviours as well as more specific study-related information. While some instruments (eg, HSCL-25, AUDIT and SWLS) were used for all three SHoT-studies, other instruments and questionnaire were specific for each study. Especially the SHoT2018 study included several new instruments, which the student welfare associations, were very interested in including in the new survey. Of particular interest were instruments assessing sexual harassment, bullying and self-harm/suicidal ideation, which so far have received little attention in student populations.
Linkage to registers covering all participants
The first two studies (SHoT2010 and SHoT2014) were anonymous, but the SHoT2018 also collected the participants’ unique Norwegian 11-digit personal identification number. This allows data from SHoT participants to be linked to several national health registers, of which the most important data sources are displayed in table 2. In terms of planned scientific use, linkages to these registries will allow us to examine a range of novel research questions, for example: The Medical Birth Registry of Norway (MBRN) may be used to identify causes of health problems and medical conditions related to pregnancy and birth, which again may linked to academic performance for specific subgroups during the college years. Furthermore, linking the SHoT2018 study to the KUHR database will, for example, allow us to examine predictive factors in SHoT2018 in relation to later primary healthcare use, and similarly, the Norwegian Patient Registry (NPR) will allow us to explore predictors and outcomes using data from the specialist care (data on diagnosis and treatment). Another scientific aim will be to link SHoT2018 to the National Educational Database (NUDB), which includes information about completed education at all levels, grades and school-drop out. This will enable us to examine potential risk and protective factors for both academic success and dropout from college/university. Finally, data from the Norwegian Social Insurance Database (FD-Trygd) will allow us to investigate the students’ later work life participation, including both risk and protective factors. As such, the additional scientific benefits, only briefly outlined here, by linking the SHoT2018 to national registers, are substantial.
Patient and public involvement
The planning and design of the study were initiated and governed by the student welfare associations, which included deciding inclusion and exclusion criteria, and selecting potential research questions and instruments. Students were not involved in the actual collection of data, although recruitment was conducted in close collaboration with all the student welfare associations in Norway. The results will be disseminated to the study participants via outlets of the student welfare associations and educational institutions, with newsletters highlighting main findings being made available to all students. Popular summaries of results and interpretations with interest for a wider audience will be disseminated in appropriate outlets (eg, the web pages of educational institutions and the NIPH).
Findings to date
Descriptive results from the SHoT2010,11 SHoT201412 and SHoT201813 have been published in three comprehensive Norwegian reports. Table 3 provides a brief overview of some of the main findings from these studies. In addition, some key findings from the SHoT2014 have been published in peer-reviewed international journals: Examining the psychometric properties of the included measure of mental health problems, the Hopkins Symptoms Check List (HSCL-25),14 Skogen et al concluded that a unidimensional model was most appropriate for HSCL-25 in student populations.15 Investigating sleep problems in college students, Hayley et al found that difficulties initiating or maintaining sleep was linked to increased risk of both social and emotional loneliness,16 as well as poorer academic outcomes and poorer self-rated academic proficiency.17 And focusing on the introductory week offered by most Norwegian higher education institutions, Myrtveit et al found that 7 of 10 students were satisfied with the introductory week, and that participation in the event was associated with better social integration, although some felt excluded due to the amount of alcohol involved.18 19
Strengths and limitations
An obvious strength is the large sample size, especially for the SHoT2018, which allows studies of low frequent conditions/variables. A notable weakness is the relatively modest response rate for both the SHoT2010 (23%), SHoT2014 (29%) and SHoT2018 (31%). It is possible that the use of a single, email-based survey approach contributed to this low response-rate, as web-based platforms typically yield lower overall participation rates when compared with traditional mail approaches, such as mail survey or face-to face interviews.20 The potential bias introduced by selective recruitment to the cohort is an obvious limitation regarding prevalence measures, but appears to have minimal influence on exposure-disease associations.21
The SHoT dataset is administrated by the NIPH. Approval from a Norwegian regional committee for medical and health research ethics (https://helseforskning.etikkom.no) is a pre-requirement. Guidelines for access to SHoT data are found at https://www.fhi.no/en/more/access-to-data.
We wish to thank all participating students as well as the three largest student associations in Norway (SiO, Sammen and SiT), who initiated and designed SHoT studies.
Patient consent for publication Obtained.
Contributors BS drafted the manuscript, with contributions from HR, EM and KJL. HR, EM and KJL designed and established the SHoT study (for the SHoT2018 also BS), and they are also responsible for the continued management of future waves. HR, EM and KJL obtained funding, and BS was responsible for data management. All authors reviewed, critically revised and approved the manuscript.
Funding SHoT 2018 has received funding from the Norwegian Ministry of Education and Research (2017) and the Norwegian Ministry of Health and Care Services (2016).
Competing interests None declared.
Ethics approval The SHoT 2018 study was approved by the Regional Committee for Medical and Health Research Ethics in Western Norway (no. 2017/1176), and electronic informed consent was obtained after complete description of the study to the participants. Approvals for conducting the SHoT2010 and SHoT2014 studies were granted by the Data Protection Officer for research at the Norwegian Centre for Research Data.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Researchers interested in collaboration are invited to propose research projects. The SHoT dataset is administrated by the NIPH. Approval from a Norwegian regional committee for medical and health research ethics (https://helseforskning.etikkom.no) is a pre-requirement. Guidelines for access to SHoT data are found at https://www.fhi.no/en/more/access-to-data.
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