The World Health Organization1 indicated that mental conditions among young adults is one of the global burdens of concern with depression being the third leading cause of the condition and suicide being the second leading cause of death among 15-29-year olds. Most mental health disorders have their highest onset during young adulthood2. Various research findings suggested that 40 million of the adults in the United States have anxiety disorder where 75% of them experienced their first episode by age 22, a typical college age3, over half of the college students in the United States had at least one mental health problem4 and more than 20% of the Hong Kong university students also suffered from either depression, anxiety or stress5.
Inferring from the above, majority of the young people in this category are in college or university. Hence, the research of undergraduate students’ mental health was a significant and crucial area to investigate. Depression, anxiety, and stress are the common issues that affect the well-being of students(6,7). The number of university students with mental illness has risen remarkably over the past few years8, specifically the number of people having depression has doubled and suicidal symptoms among students has tripled over the same period. In Malaysia, the NHMS9 found that 29.2% of the adult population have suffered some form of mental illness compared to 10.7% in 1996 suggesting that prevalence rate has doubled over that period. The number of adults who suffered from emotional issues has increased to about 30% in 2015. Among the groups of adults, 15.7% were students who suffered from depression, anxiety and stress in Malaysia9. The statistics also indicated that the rate of increase tripled in 20 years. The statistics reflected the higher education students as they are often viewed as elite or a privileged group, but they are not exempted from suffering with disability related to mental illness10.
The Malaysian Mental Healthcare Performance technical report11 revealed that the prevalence of mental health problems among individuals above 16 years old is slightly higher for female (30.8%) as compared to males (27.6%). Furthermore, similar finding has also been proposed12 in their study where they demonstrated that in Malaysia, depression (17.7%), anxiety (39.5%), and stress (10.1%) were among the top three mental health issues reported by 25, 507 students. Adding on, according to Keyes et al.13 common form of mental illness prevalent among college students are depression and anxiety. Hence, their finding is consistent with the statistics from Malaysian Mental Health Performance report11 which indicates that students who screen positive results for a mental illness are at high risk of developing suicidal behaviour. Although this research does not directly explain the context with relation to suicidal ideation research, suicide is considered as a consequence of depression, anxiety and stress.
When looking at western countries for instance, the United States, the most prevalent mental illness among college students is also anxiety disorders with estimated 12% of students suffering from it. Another typical mental health problem is depression with estimated 7–9% in college students. A study on the mental health of 190 students in Malaysia indicated that 11.10% of students reported severe level of depression, 10.00% for severe level of anxiety, and 9.5% for severe level of stress14. In addition, research has also shown that depression, anxiety and stress often time lead to suicide12. Although suicide is not a disability, among Malaysian youth − 7% of them reported having suicidal ideation and the majority of them turned it into action15. Consistent with this finding a past paper has suggested that mental illness in the form of depression and anxiety is prevalent among college students7. Furthermore, students who were screened positive for mental illnesses are at higher risk of suicidal behaviour and poor academic performance13.
Moving on, mental well-being includes psychological attributes such as students’ interest in their course of study, their coping mechanisms with respect to academic issues, and their attitudes towards cultivating the development of personal core competencies, engagement with outsiders by connecting with people and professional self-perceptions16. These characteristics have effects on the educational productivity as a whole17. The educational productivity theory postulates that when a person is having psychological issues such as depression, anxiety, and stress, their educational results will be affected in a negative way. Higher level of stress also reported poorer social skills where individual’s ability to seek for social support and engage socially were greatly impaired18. If an individual fail to satisfy this need for belonging, it led way to negative outcomes such as dissatisfaction with life or poor performance. Since unfulfilled needs will lead to dissatisfaction of interpersonal needs, it causes one unable to hit the target, therefore further increase the level of mental issues which can affect the academic performance indirectly19. Many researches have been conducted that explores relationship of various psychological variables such as depression, stress, anxiety, and satisfaction with life (SWL)(20–25). However, there is a very limited study conducted to examine the role of interpersonal needs such as thwarted belongingness and perceived burdensomeness as the moderating factors in the relationship among depression, stress, anxiety, and SWL of undergraduate students.
The Current Study
Based on the above-cited approach and research findings, this study aims to discover whether interpersonal needs act as a moderating factor and has an impact on SWL of undergraduate students in Malaysia. This study intends to find out the relationship between depression, anxiety, and stress on SWL of undergraduate students in two private universities in Malaysia with the effect of interpersonal needs as a moderator. The perceived burdensomeness and thwarted belonging act as the constructs of interpersonal needs.
Depression, Anxiety, Stress, And Swl
Students are generally adolescents who are susceptible to positive and negative affective conditions that determine their state of happiness or well-being. Their wellness motivated the current study to focus on the effects of negative affective conditions, specifically depression, anxiety, and stress on SWL. To ensure the students’ mental health wellness, universities need to monitor their student’s mental health continuously and systematically. It is normal that Institutions regularly conduct surveys on the well-being of their students. Such monitoring methods would permit the universities to assess the mental wellbeing of the of students and the survey results can assist them in improving the viability of their existing counselling programs26.
One past study indicated that severe levels of depression, anxiety and stress are highly associated with low life satisfaction among university students27. These negative affective conditions, ranging from depression to stress, are not healthy emotional symptoms and may affect the subjective well-being of individuals. Although well-being composed of affective and cognitive components28, this study takes an interest on the latter component on the grounds that individuals who are empowered and exposed to social media makes conscious cognitive judgements of their life based on self-defined criteria of ‘a good life’. Similarly, Boyraz, Waits and Felix29 found significant association between authenticity and life satisfaction and decreased distress. Their findings re-emphasized the importance of helping clients to minimize the incongruence between their true self and experiences in fostering their adjustment and well-being. These aforementioned literatures explain how lower life satisfaction is a product of inability by individuals to have congruency between ideal self and real self.
On the other hand, greater attachment anxiety is associated with greater depressive symptoms, whereas attachment avoidance was unrelated to depressive symptoms30. Attachment anxiety is usually associated with greater self-criticism, hypervigilance of cues of disapproval from people in their surroundings, and feelings of unworthiness of love. These cognitions may lead to excessive negative affect and depressive symptoms. Thus, based on the reviews, this study hypothesized that:
H1: Depression is negatively associated with SWL
H2: Anxiety is negatively associated with SWL
H3: Stress is negatively associated with SWL
The role of interpersonal needs and SWL.
According to Maslow31 who coined hierarchy of needs theory, individuals strive to fulfil the basic needs such as the physiological needs and safety needs before achieving the belongingness needs, esteem needs, and self-actualization needs. Undergraduate students fulfil their belongingness needs via the interpersonal interactions with the others. These students are in developmental stage of identity vs. role confusion and intimacy vs. isolation as suggested by Erikson32. They are at the age where self-identity is being developed and one of the key elements which contributed to the formation of self-identity is the feeling of belongingness. Feeling of belongingness comes from the interaction and recognition of the individuals around them. Failure to form such close social interactions with the surrounding triggers the feeling of thwarted belongingness. Thwarted belongingness is an interpersonal need that should be fulfilled, and undergraduate students need interpersonal attachment with their social circle to create sense of belonging in the respective social circle.
Thwarted belongingness is categorized as the social or belongingness needs, the third level needs among the five levels in the Maslow’s hierarchy of needs33. For individuals to score in their academic performance, which is related to the esteem needs, they need to fulfil their social needs beforehand34. This explains that inability of an individual to achieve need for belongingness hinders them from achieving higher level of self. It further increases the chances of experiencing depression, anxiety, and stress which have a reverse effect on academic performance35.
Øverup et al.30 mentioned that self-criticism and feelings of unworthiness would contribute in developing symptoms of anxiety and depression. Indeed, in the main analyses, Øverup et al.30 found that interpersonal needs such as perceived belongingness and perceived burdensomeness mediates the relationship between attachment anxiety and depressive symptoms. Interestingly and in contrast, perceived belongingness would serve as a moderator in the current study. Perceived belongingness occurs in relationships with others and it is inclusive of perceived burdensomeness and thwarted belongingness. These factors are found to have important associations with suicidal ideation among college students36 where stressful life events experienced during adolescence could be overwhelming and students who are able to adjust their assumptions about the world and their self-identity have less suicidal risk. The decreased suicidal risk is even when the perceptions of lack of belongingness and burdensomeness co-exist. Thus, it is possible to make meaning of stressful life events, eventually free from depression and anxiety. The meaningful transformation would eventually and indirectly increase the students’ SWL.
In the context of the current study, interpersonal needs refer to individuals’ desires and divided into perceived burdensome and thwarted belongingness. There is scarce research which focuses on this area among undergraduate students compared to psychiatric patients(37,38). According to Van Orden, Cukrowicz, Witte, and Joiner39 both constructs of perceived burdensome and thwarted belongingness are pivotal and considered to be the most proximal interpersonal needs that lead to suicidal ideation. Other conditions such as mental disorders and stressful life events are comparatively more distant in the chain of risk but fortunately, perceived burdensomeness and thwarted belongingness are postulated as dynamic and obedient to therapeutic change.
Perceived burdensomeness is a mental state that a person has developed the perception that others would “be better if I were gone”. Such a mental state is a result of an unmet social ability, a pre-condition that is supported by other frameworks such as self-determination theory which explains importance of human’s innate need for connection and relatedness that allows them to grow and become competent in managing their life40. On the other hand, Van Orden et al.39 pointed out that the perception of being a burden to others can be induced by multiple factors, including functional impairment(41–43), unemployment44 and family discord45. These factors induce the perception of burdensomeness, which could lead to lower SWL and thoughts of attempt for suicide. Thus, we have hypothesized that:
H4: Perceived burdensome moderates the relationship between depression, anxiety and stress on SWL.
H5: Thwarted belongingness moderates the relationship between depression, anxiety and stress on SWL.
Our research framework is illustrated in Fig. 1.
INSERT FIGURE 1HERE