The number of studies relevant to each conclusion is shown in square brackets in all Conclusions and Future Directions sections.
However, the cross-sectional study design prevents us from drawing conclusions about the direction of the link: poorly perceived adjustment to the academic environment may increase the risk of psychiatric disorders or psychiatric disorders may increase the difficulties in adjusting to the academic environment, or both may be caused by other factors not investigated here [ 19].
Therefore, among the trials with a randomised design, we will also assess the direction of publication conclusions and investigate whether the direction of publication conclusions is associated with discrepancies between protocol and publication.
This may have altered the magnitude of our findings but would not affect the overall associations or direction of our conclusions.
Thus, unblinding is unlikely to have influenced the direction of our conclusions.
The degree of the risk of reporting bias depends on the association of discrepancies with the direction of trial conclusions.
Among the trials with a randomised design, we will classify the direction of publication conclusions as either positive or negative.
The secondary objective of this study is to investigate whether selective publication is associated with the direction of trial conclusions.
According to the objectives of the study, we will analyse three end points (table 1): non-publication, discrepancies between the protocol and the publication as a proxy for selective publication and the direction of publication conclusions.
This classification is included to investigate whether discrepancies are associated with the direction of the conclusions (and the interpretation) that the authors draw in the discussion sections of the publications.
A sensitivity analysis on the impact of the four excluded trials,w1-w4 based on effect sizes, indicated that their inclusion would have a neutral to inflating effect on the results, without changing the direction of the conclusions.
