Predictors, patterns, and correlates of moderate-severe psychological distress among New York City College Students during Waves 2-4 of COVID-19.

The COVID-19 pandemic may have exacerbated mental health conditions by introducing and/or modifying stressors, particularly in university populations. We examined longitudinal patterns, time-varying predictors, and contemporaneous correlates of moderate-severe psychological distress (MS-PD) among college students. During 2020-2021, participants completed self-administered questionnaires quarterly (T1 = 562, T2 = 334, T3 = 221, and T4 = 169). MS-PD reflected Kessler-6 scores ≥ 8. At T1 (baseline), most participants were cisgender women [96% vs. 4% transgender/gender non-conforming (TGNC)]. MS-PD prevalence was over 50% at all timepoints. MS-PD predictors included low self-rated health and perceptions of local pandemic control, verbal/physical violence experience, food insecurity, cohabitation dynamics, geographic location, and loneliness. Unique MS-PD correlates encompassed drug use and TGNC identity. Trajectories comprised Persistently (40%), Highly (24% MS-PD twice/thrice), Minimally (15% MS-PD once), and Never (21%) Distressed. Persistently Distressed students had low social support and self-rated health; high food insecurity, drug use, physical/verbal violence experience, need-based financial aid, and TGNC representation; and fluctuating self-rated health amid increasing COVID-19 symptomatology. In this sample, MS-PD prevalence was high, persistent, and associated with financial, behavioral, structural, experiential, and intra- and inter-personal factors. Given its complexity, improving and preserving college students' mental health necessitates comprehensive, multi-component activities to change adjustable stressors while attenuating the adverse effects of immutable influences.