Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study

Relationship between social support and depressive symptoms among internal migrant workers and the mediating role of healthy lifestyle: a cross-sectional study in China

OBJECTIVES

To investigate the association between social support and depressive symptoms among internal migrant workers with a focus on the mediating role of a healthy lifestyle.

DESIGN

Cross-sectional study.

SETTING

The research was conducted among internal migrant workers in Henan Province, China, in August 2023.

PARTICIPANTS

Internal migrant workers are defined as individuals residing outside their registered household location (excluding mobility within the municipal district) and participating in various social and economic activities, including employment, entrepreneurship and social services.

PRIMARY OUTCOME MEASURES AND ANALYSES

Social support was measured using the Chinese version of the social support rating scale. The severity of depression among the study participants was evaluated using the Patient Health Questionnaire-9. A healthy lifestyle was assessed based on the questionnaire we developed based on the American Medical Association Healthy Lifestyle Scale. Statistical analyses, including logistic regression, Spearman's correlation and mediation analysis, were deployed to explore the associations between social support, healthy lifestyle and depressive symptoms.

RESULTS

Among 19 326 participants, 21.45% exhibited depressive symptoms, with a higher prevalence observed among males. Social support levels among internal migrant workers were found to be lower than those in the general population, and higher social support was significantly associated with a decreased risk of depressive symptoms (OR=0.102, 95% CI: 0.086 to 0.121). Mediation analysis revealed that a healthy lifestyle partially mediated the relationship between social support and depressive symptoms among internal migrant workers, with a mediation effect of -0.063, accounting for 18.75% of the total effect.

CONCLUSION

This study provides insights into the complex interplay between social support, healthy lifestyle and depressive symptoms among internal migrant workers in China. Implementing interventions aimed at enhancing social support and promoting healthy lifestyle behaviours can significantly improve the mental health and overall well-being of internal migrant workers.

Understanding the relationship between smartphone distraction, social withdrawal, digital stress, and depression among college students: A cross-sectional study in Wuhan, China

Background

Smartphone distraction considerably affects the depression level of college students. These two variables are highly associated with social withdrawal and digital distress. However, the underlying mechanisms of how social withdrawal and digital stress were involved in the relationship between smartphone distraction and depression remain unclear.

Methods

A cross-sectional survey was conducted in seven colleges of Wuhan, Hubei Province, from September to November 2021. Participants were selected using convenience sampling. Smartphone distraction, social withdrawal, digital stress, and depression level were assessed using the Smartphone Distraction Scale (SDS), 25-item Hikikomori Questionnaire (HQ-25), Multidimensional Digital Stress Scale (DSS), and the Patient Health Questionnaire-9 (PHQ-9), respectively. All scales demonstrated good reliability in this study, the reliability of each scale was 0.920, 0.884, 0.959, and 0.942.

Results

The final analysis included 1184 students (692 males and 492 females), aged between 17 and 37 years. Participants were from various academic disciplines, including medical and non-medical. The findings revealed that smartphone distraction had a significant direct effect on depression (c = 0.073, 95 % CI: 0.037 to 0.108, p < 0.001) and three significant indirect mediation effects: (1) social withdrawal (B = 0.083, 95 % CI: 0.066 to 0.101, p < 0.001), accounting for 27.76 % of the total effect; (2) digital stress (B = 0.109, 95 % CI: 0.088 to 0.132, p < 0.001), accounting for 36.45 % of the total effect; and (3) the chain mediating roles of social withdrawal and digital stress (B = 0.034, 95 % CI: 0.026 to 0.043, p < 0.001), accounting for 11.37 % of the total effect. The total mediating effect was 75.59 %.

Limitations

This study is based on cross-sectional data, which limits the causality inference.

Conclusions

These findings suggest that educational institutions should identify college students with excessive smartphone use early and provide timely interventions to minimize negative outcomes. It is also significant to reduce the risk of social withdrawal and digital stress to maintain the physical and mental health development of college students.

Psychological distress, health-promoting lifestyle and sociodemographic factors in Honduran university students: a structural equation model

This study sought to analyze an explanatory model on the relationship among sociodemographic factors, health-promoting lifestyle behaviors and psychological distress (depression, anxiety and stress) in college students. This is an observational, analytical and cross-sectional study conducted on a national sample of 4203 students who entered a macro university in Honduras in 2021, 2022 and 2023. We used a sociodemographic survey, the Health-Promoting Lifestyle Profile (HPLP-II) and the Depression, Anxiety and Stress Scales (DASS-21). Univariate analysis and a multivariate structural equation model were conducted. The average HPLP-II score was 117.45 (± 23.41), and the average DASS-21 score was 20.06 (± 14.16). The multivariate model showed a good data fit (comparative fit index = 0.951; Tucker-Lewis index = 0.957; root mean square error of approximation = 0.067 [90% CI = 0.067-0.068]). Results indicate that being a woman (β = 0.11; p < 0.001) and being enrolled in biological and health sciences (β = 0.09; p < 0.001) significantly predict HPLP-II scores. Furthermore, being a woman (β = 0.17; p < 0.001), age (β = 0.10; p < 0.001) and having pre-existing medical conditions (β = 0.16; p < 0.001) significantly explain part of the variance of DASS-21. A significant reverse relationship between health-promoting behavior and psychological distress was shown (r = -0.36; p < 0.001). This study identifies protective and risky sociodemographic factors linked to health-promoting lifestyle behaviors and psychological distress. Our findings have implications for developing comprehensive intervention policies and strategies to promote health in higher education settings.

Promoting new users' online health consultation services usage behavior strategically

Online consultation services have the potential to reduce the workload of healthcare staff, provide timely care to patients, and improve doctor-patient relationships. The COVID-19 pandemic has accelerated the development of these services and platforms, but it remains to be seen whether the general public will continue to use them after the pandemic is under control. This research proposes a framework to examine the factors contributing to UK adults' continued usage of online healthcare consultation services after COVID-19 restrictions have been lifted. A total of 430 new users completed surveys, and the results indicate that expectation confirmation, system quality, and information quality can positively impact users' self-efficacy toward using online consultation services. This, in turn, can influence their continued usage behavior. Furthermore, the results suggest that participants' perception of health risks can moderate the relationship between self-efficacy and continued usage behavior. The strategic implications of these findings are discussed.

The impact of problematic mobile phone use and the number of close friends on depression and anxiety symptoms among college students

Background

Psychological problems often occur in college students, with the most common ones being depression and anxiety symptoms. Exploring the risk factors that influence depression and anxiety symptoms in college students is essential to promote their physical and mental health.

Objective

This study aimed to investigate the independent and interaction effects of problematic mobile phone use (PMPU) and the number of close friends (NCFs) on depression and anxiety symptoms and the comorbidity of these symptoms among college students.

Methods

A cross-sectional survey was conducted in Huainan, Anhui Province, and Suzhou, Jiangsu Province in China from October to December 2022. Data from 7,617 college students were collected. The Patient Health Questionnaire and Generalized Anxiety Disorder-7 were used to evaluate depression and anxiety symptoms. The PMPU data were collected by the Mobile Phone Addiction Type Scale. Multinomial logistic regression models were performed to examine the associations of PMPU and NCFs with depression and anxiety symptoms and their interaction effects.

Results

PMPU and lack of close friends significantly increased the risk of depression and anxiety symptoms and the comorbidity of these symptoms in college students (p < 0.001). In addition, the effects of PMPU and lack of close friends on depression and anxiety symptoms in college students were interactive (p < 0.001). No significant sex differences were found.

Conclusion

PMPU and lack of close friends are important risk factors for depression, anxiety, and the comorbidity of these symptoms in college students in China.

The relationship between depression, healthy lifestyle behaviors and internet addiction: a cross-sectional study of the athlete university students in Turkey

Introduction

Mental health research exists for university students in the areas of prevalence and association of depression, internet addiction and healthy lifestyle behaviors. However, the studies examining prevalence rates and these relationships in athlete university students are needed. This study aimed to evaluate the relationship between depression, healthy lifestyle behaviors and internet addiction among athlete university students in Turkey.

Methods

A cross-sectional design was conducted, measuring depression using the Center for Epidemiologic Studies Depression Scale, healthy lifestyle behaviors (HPLP-II), and internet addiction (YIAT-SF). Predictive factors associated with depressive symptoms were estimated using binary logistic regression.

Results

Of the 501 participants, 61.3% were male, with a mean age of 21.45 years (SD: 3.19). Student-athletes were at risk of depressive symptoms (76.4%), internet addiction (34.4%) and had moderate healthy lifestyle behaviors (130.41 ± 22.93). No significant differences were found for age, smoking, time spent on social network, number of sports days, number of social networks use for depressive symptoms (p > 0.05), however significant differences were found for depressive symptoms by sex and living with family status (p < 0.05). Pathological internet addiction (OR: 12.74, 95% CI: 2.91-55.77) and low spiritual growth (OR: 0.854, 95% CI: 0.79-0.92) were found to be predictors of depressive symptoms within the athlete university students (p < 0.001).

Conclusion

The athlete university students are at increased risk for depressive symptoms and internet addiction and decreased healthy lifestyle behaviors. It is essential to establish programs to improve the mental health of students in universities and to strengthen the psychological counseling services offered to students. These findings can assist universities in establishing effective measures to improve mental health outcomes.

Sleep quality, social rhythms, and depression among people living with HIV: a path analysis based on social zeitgeber theory

Background

People living with HIV frequently report sleep disturbances. The social zeitgeber theory, which proposes that stressful life events can interfere with sleep and even depression by destabilizing daily routines, provides new insights into identifying predictors of sleep disturbances and improving sleep in people living with HIV.

Objective

To explain the pathways affecting sleep quality in people living with HIV based on social zeitgeber theory.

Methods

A cross-sectional study was conducted to assess sleep quality, social rhythms, depression, social support, and coping styles from December 2020 to February 2021. The hypothetical model was tested and respecified by performing path analysis and a bias-corrected bootstrapping method using IBM AMOS 24 software. The report of this study followed the STROBE checklist.

Results

A total of 737 people living with HIV participated in the study. The final model presented a good fit (goodness of fit = 0.999, adjusted goodness of fit index = 0.984, normed fit index = 0.996, comparative fit index = 0.998, Tucker-Lewis index = 0.988, root mean square error of approximation = 0.030, chi-squared/degree of freedom = 1.646), explaining 32.3% of the variance in sleep quality among people living with HIV. Lower social rhythm stability was directly associated with poorer sleep quality, and depression mediated the relationship between social rhythms and sleep quality. Social support and coping styles affected sleep quality through social rhythms and depression.

Limitation

The cross-sectional study design precludes making assumptions about causality among factors.

Conclusion

This study validates and extends the applicability of the social zeitgeber theory in the HIV context. Social rhythms have direct and indirect effects on sleep. Social rhythms, sleep, and depression is not simply linked in a cascading sequence but is theoretically linked in a complex way. More studies are needed to explore the predictors of social rhythms, and interventions for stabilizing social rhythms have the potential to alleviate sleep disturbances and depression in people living with HIV.

Association between parental control and depressive symptoms among college freshmen in China: The chain mediating role of chronotype and sleep quality

BACKGROUND

College freshmen tend to have more psychological and behavioral problems compared with other populations, especially depressive symptoms. Perceived parental control has been proved to play a significant role in mental health among children and adolescents. Based on the theoretical and empirical research of chronotype and sleep quality, this study constructed a chain mediating model to examine whether they mediated the relationship between parental control and depressive symptoms among Chinese college freshmen.

METHODS

A total of 2014 college freshmen from Dali University were recruited to participate in this study and completed self-report Parental Bonding Instrument (PBI), Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Depression Scale (SDS). PROCESS 3.5 for SPSS was applied to determine the chain mediating effect of chronotype and sleep quality between parental control and depressive symptoms.

RESULTS

College freshmen with depressive symptoms have higher levels of parental control and worse subjective sleep quality than normal population (all p < 0.001). All study variables are correlated with each other, while chronotype has no significant association with depressive symptoms (r = -0.03, p > 0.05). Both maternal and paternal control have a direct link with depressive symptoms (β = 0.86, p < 0.001; β = 0.88, p < 0.001). Parental control could affect depressive symptoms via the independent mediating effect of sleep quality and the chain mediating effect of chronotype and sleep quality. The total indirect effects of maternal and paternal control on depressive symptoms are 0.93 and 0.94, respectively.

CONCLUSIONS

Chronotype and sleep quality could mediate the association between parental control and depressive symptoms.

Influencing factors, prediction and prevention of depression in college students: A literature review

The high prevalence of depression among college students has a strong negative impact on individual physical and mental health, academic development, and interpersonal communication. This paper reviewed the extant literature by identifying nonpathological factors related to college students' depression, investigating the methods of predicting depression, and exploring nonpharmaceutical interventions for college students' depression. The influencing factors of college students' depression mainly fell into four categories: biological factors, personality and psychological state, college experience, and lifestyle. The outbreak of coronavirus disease 2019 has exacerbated the severity of depression among college students worldwide and poses grave challenges to the prevention and treatment of depression, given that the coronavirus has spread quickly with high infection rates, and the pandemic has changed the daily routines of college life. To predict and measure mental health, more advanced methods, such as machine algorithms and artificial intelligence, have emerged in recent years apart from the traditional commonly used psychological scales. Regarding nonpharmaceutical prevention measures, both general measures and professional measures for the prevention and treatment of college students' depression were examined in this study. Students who experience depressive disorders need family support and personalized interventions at college, which should also be supplemented by professional interventions such as cognitive behavioral therapy and online therapy. Through this literature review, we insist that the technology of identification, prediction, and prevention of depression among college students based on big data platforms will be extensively used in the future. Higher education institutions should understand the potential risk factors related to college students' depression and make more accurate screening and prevention available with the help of advanced technologies.

Prevalence and Predictors of Anxiety and Depressive Symptoms Among International Medical Students in China During COVID-19 Pandemic

Background: The rapid spread of Coronavirus Disease-19 (COVID-19) infection has been the most important public health crisis across the globe since the end of 2019. Anxiety and depression are the most common mental health problems among people during the pandemic, and many studies have reported anxiety and depressive symptoms in college students. However, information on the mental health status of international medical students during this critical period of time has been scarce, which hinders the efforts in making proper policy or strategies to help these students. The present study aims to explore the prevalence of anxiety and depressive symptoms in international medical students in China and to find out the factors that have potential predictive value for anxiety and depressive symptoms. Method: A cross-sectional study was carried out for international medical students during November 2020 at China Medical University in Shenyang, China. Five hundred and nineteen international students were interviewed with questionnaires containing demographic variables, Stressors in school, Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), Perceived Stress Scale (PSS-10), the Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R) and Resilience Scale-14 (RS-14). Univariate logistic regression and stepwise multiple logistic regression analyses were conducted where appropriate to explore the predictive factors of anxiety symptoms and depressive symptoms. Results: The prevalence of anxiety symptoms and depressive symptoms in the sample population was 28.5% (148/519) and 31.6% (164/519), respectively. Stressors in school (β = 0.176, OR = 1.192, CI: 1.102-1.289), negative coping style (β = 0.639, OR = 1.894, CI: 1.287-2.788) and perceived stress (β = 0.230, OR = 1.258, CI: 1.184-1.337) were found to be the predictors of anxiety symptoms among the international medical students; while gender (β = -0.594, OR = 0.552, CI: 0.315-0.968), stay up late (β = 0.828, OR = 2.288, CI: 1.182-4.431), current place of residence (β = 1.082, OR = 2.951, CI: 1.256-6.931), stressors in the school (β = 0.303, OR = 1.354, CI: 1.266-1.496), negative coping style (β = 0.866, OR = 2.377, CI: 1.516-3.725), perceived stress (β = 0.233, OR = 1.262, CI: 1.180-1.351) were found to be predictors of depressive symptoms. Conclusion: The prevalence of anxiety symptoms and depressive symptoms was moderate among international medical students in China. The communal predictors of anxiety and depressive symptoms were stressors in school, negative coping style and perceived stress; while demographic factors such as gender (male), stay up late at night and current place of residence were found associated with depressive symptoms. These results suggest that proper stress management and specific interventions are needed to help students maintain their mental health during the COVID-19 pandemic period.