Depression, Anxiety, Stress, and Satisfaction with Life: Moderating Role of Interpersonal Needs among University Students

Abstract

Background Depression, anxiety, and stress are ranked among the top mental health concerns faced by university students. The transition to higher education coincides with a new social environment and adaptation that has potential to increase mental health conditions. However, limited studies in Malaysia have examined the relationship among depression, anxiety, stress, and satisfaction with life with interpersonal needs. Thus, this study was performed to assess the relationship among depression, anxiety, stress, and satisfaction with life, with interpersonal needs (perceived burdensomeness and thwarted belongingness) as moderators.  

Method A cross-sectional study using convenient sampling method was conducted among 430 students (Mean aged= 20.73 years; SD = 1.26 years) in two private universities in Malaysia. A self-administered questionnaire comprising the Depression, Anxiety and Stress Scale (DASS-21), Satisfaction with Life Scale, and Interpersonal Needs Questionnaire were used.

Results Students who experienced depression and anxiety reported higher satisfaction with life under the influenced of low perceived burdensomeness. Perceived burdensomeness, when coupled with depression (β = 0.76, p < 0.01) and anxiety (β = 0.79, p < 0.01), contributed 15.8% of variance in satisfaction with life. Students who experienced stress reported higher satisfaction with life under the influence of high thwarted belonginess (β = 0.73, p < 0.01), contributing 17.0% of variance in satisfaction with life.  

Conclusions For university students who experienced depression and anxiety symptoms, mental health practitioners, researchers, and teaching staff may need to be aware and educate the students on how to reduce and manage their perceptions on perceived burdensomeness. For university students who experienced stress symptoms, the focus shall not be solely on managing perception towards thwarted belonginess as it is not necessarily perceive as a negative ‘interpersonal need’ in this study. Future studies are required to substantiate this result. 

Background

The World Health Organization indicated that mental health conditions among young adults is one of the global areas of concern, with depression being the third leading condition and suicide being the second leading cause of death among individuals aged between 15 and 29 [1]. The onset of most mental health disorders occurs during young adulthood [2]. Various studies have reported that 40 million adults in the United States have anxiety disorder, of which 75% of them experienced their first episode at age 22, a typical college age [3]. Depression, anxiety, and stress are the common issues that affect the well-being of students [4]. In Malaysia, the number of university students with mental health conditions has risen remarkably over the past few years; specifically, the number of people living with depression has doubled and suicidal symptoms among students has tripled over the same period [5].

A study done in 20I6  showed that 29.2% of Malaysian adults had reported some form of mental health conditions compared to 10.7% in 1996, suggesting that the prevalence rate has doubled over that period [5]. The Malaysian Mental Healthcare Performance: Technical Report 2016 indicated further that younger adults who experienced emotional issues had increased to 29.2% in 2015 with depression (17.7%), anxiety (39.5%), and stress (10.1%) being the top three mental health conditions reported by 25,507 students nationwide [6, 7]. Furthermore, these students are also at high risk of developing suicidal behaviour [8], and exhibit poor academic performance [9].

As such, with almost 1.3 million Malaysian youths in college or university [10], studies on mental health conditions and the well-being of students are significant and crucial to promote positive mental health among college and university students [11].

Depression, anxiety, stress, and SWL

Students are typically young adults who are susceptible to positive and negative affective conditions that determine their state of happiness or well-being. Hence, these factors motivated the current study to focus on the effects of negative affective conditions, specifically depression, anxiety, and stress, on satisfaction with life (SWL). To ensure mental health wellness among students, universities typically monitor the students’ mental health continually and systematically by conducting surveys from time to time. Universities are able to assess the mental well-being of their students and also use the survey results to assist them in improving the viability of their existing counselling programmes [12].

One past study indicated that severe levels of depression, anxiety, and stress are strongly associated with low life satisfaction among university students [13]. These negative affective conditions—depression, anxiety, and stress—are not healthy emotional symptoms and may affect the subjective well-being of individuals. Well-being comprises affective and cognitive components [14].  This study focused on the latter as young adults who are Generation Z – presently aged from 5 to 25 –who grew up in a highly tech-savvy age. They are well connected virtually, enjoy digital lives [15] and long for connection, sense of belongingness and interpersonal needs [16].

Most of the research found that university students’ satisfaction with life has a negative correlation with depression. Their findings suggest that to improve life satisfaction, the focus must be on effective intervention and management of depression issues among the university students [17, 18]. In addition, greater anxiety is associated with greater depressive symptoms [19] where individuals reported greater self-criticism, hypervigilance of cues of disapproval from people in their surroundings, and feelings of being unworthy of love. Tsitsas, Nanopoulos and Paschali (2019) also indicated that university students score higher in life satisfaction when their anxiety scores are low [20]. Their result suggested a negative association between the life satisfaction and anxiety. On another note, Boyraz et al. [21] found significant association between authenticity, life satisfaction, and decreased distress.

Some research has shown that university students who experience higher depression, anxiety and stress in life have lower level of life satisfaction [13], [22]. These negative association are in line with a systematic literature review which stated that quality of life among university students has a negative correlation with stress. The factors highlighted were burnout, sleep disturbances and depression which escalate the negative association with quality of life [23].

Thus, based on the reviews aforementioned, we hypothesised 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

In the current study, interpersonal needs refer to individuals’ desires and comprises perceived burdensomeness and thwarted belongingness. There is scarce research in this area that examines these factors among university students as most studies are conducted on psychiatric patients [24, 25]. According to Van Orden et al. [26], both perceived burdensomeness and thwarted belongingness are pivotal constructs and considered to be the most proximal interpersonal needs that lead to suicidal ideation. Other constructs, such as mental health conditions and stressful life events, are comparatively more distant in the risk chain of suicidal ideation. Perceived burdensomeness and thwarted belongingness, fortunately, are postulated as dynamic and obedient to therapeutic change. In view of that, both constructs are viable moderating variables to explain how the relationship among depression, stress, anxiety, and SWL changes among individuals with low or high interpersonal needs.

According to Maslow’s hierarchy of needs theory [27], individuals strive to fulfil their basic needs, such as physiological needs and safety needs, before striving to achieve their belongingness needs, esteem needs, and self-actualisation needs. Thwarted belongingness is categorised as social or belongingness needs, the third level of the five levels of needs in Maslow’s hierarchy [28]. For university students, they fulfil their belongingness needs through their interpersonal relationships as they are in the developmental stages of “identity versus role confusion” and “intimacy versus isolation” as suggested by Erikson [29]. They are developing their self-identity and achieving a feeling of belongingness, which comes from interacting with and being acknowledged by the individuals around them, which contribute to this development. Failing to form close social interactions trigger the feeling of thwarted belongingness and lead to suicidal ideation behaviour [30].  

To do well academically, which is related to esteem needs, students need to fulfil their social or belongingness needs beforehand [31]. Øverup (2017) study presented the importance of interpersonal needs, specifically perceived belongingness and perceived burdensomeness in mediating the relationship between anxiety and depressive symptoms [21]. Perceived burdensomeness is an individual’s mental state in which he or she perceives himself or herself as a burden to others. The perception that others would “be better off if I were gone”, is a result of an unmet social ability. This mental state explains the role of individuals’ innate need for connection and relatedness in allowing them to grow and become competent in managing their life [32]. This unmet social ability could lead to lower SWL among young adults who may or may not have experienced symptoms of depression, anxiety, and stress. [26]. Thus, this present study posited that students are hindered from achieving a higher level of the self-esteem if their belongingness needs are not fulfilled- making the thwarted belongingness a moderator in this study. This further increases their chances of experiencing depression, anxiety, and stress.

Although Van Orden et al. [26] proposed that unmet interpersonal needs contribute to suicidal ideation, our study focus is on SWL instead of suicidal ideation because the sample of university students in this study exhibit neither high clinical severity nor high suicidal risk. The study posits that satisfaction with perceived belongingness would lead to SWL- making perceived belongingness the moderator.

Thus, we hypothesised that:

H₄:       Perceived burdensomeness moderates the relationship between depression, anxiety, and stress on SWL.

H₅:       Thwarted belongingness moderates the relationship between depression, anxiety, and stress on SWL.

Our study aims to discover whether interpersonal needs will moderate the relationship among depression, anxiety, stress, and SWL of university students in two private universities in Malaysia with perceived burdensomeness and thwarted belongingness acting as the constructs of interpersonal needs.

Our research framework is illustrated in Figure 1.

Method

Participants

Participants (N = 430) were recruited from private universities in Malaysia using convenient sampling method. Self-administered questionnaires in English were distributed to participants upon receiving approval from the institutional review board (SUREC 2018/044). Participating students were enrolled in the following programmes: Pre-University (N = 15), Diploma (N = 11), Undergraduate Degree (N = 397), and Postgraduate Degree (N = 7). Of the participants, 73.3% of them were between the ages of 19 and 21). Participants reported sex assigned at birth and female participants accounted for 58.6% of the responses whereas male participants accounted for 40.9%. Most of the participants were local students (90.0%) and some were international students (9.8%). In terms of family structure, participants reported the following: (i) extended family, composed of grandparents, parents, children, or relatives (38.4%), (ii) immediate family, composed of parents and children (53.5%), (iii) single-parent family, composed of father or mother and children (7.6%) and others (0.5%) Table 1 illustrates the demographic background of the participants both in frequency and percentage.

Table 1. Demographic characteristics of participants

DASS-21 Questionnaire (DASS). DASS is made up of three subscales, namely depression, anxiety, and stress. Each item in the questionnaire is rated on a four-point Likert scale, ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much, or most of the time) for respondents to select their answers [33]. DASS is widely used and has been validated to assess the severity of depression, anxiety, and stress among different samples [34]. Depression is defined as a state of mind where the individual loses self-esteem and incentives, as if believing that he or she is incapable of achieving life-defining goals [35]. Anxiety is characterised as physiological hyper arousal, where the individual experiences nervousness, fearfulness, and autonomic arousal [35, 36]. Stress is characterised as negative affect or emotional state of mind, where the individual experiences persistent arousal, tension, and tolerates a low threshold for becoming upset and frustrated [35], DASS assesses stress as difficulty in relaxing, nervous arousal, easily upset or agitated, irritable or over-active, and impatient. One past study indicated that severe levels of depression, anxiety, and stress are highly associated with low life satisfaction among university students [13]. We selected DASS- 21 version as it is known to have good internal consistency and stable factor analysis structure to provide a desirable convergence to the study [37-40].  

Interpersonal Needs Questionnaire (INQ). INQ is used to measure interpersonal needs in participants: nine items measure thwarted belongingness and six items measure perceived burdensomeness (see Appendix) [26]. Unlike DASS-21, items in INQ are rated on a five-point Likert scale, ranging from 1 (Not at all true for me) to 5 (Very true for me) [41]. Van Orden et al. [26] suggested that thwarted belongingness and perceived burdensomeness are closely related yet highly distinctive aspects within areas of psychology. They also explained that INQ has been subject to multiple group analyses among younger versus older adults and clinical versus non-clinical samples, and found applicable to diverse populations. Previous studies mentioned that the scores derived from this scale provides good validity and psychometric properties [26]. Hence, INQ is reliable enough to assess thwarted belongingness and perceived burdensomeness.

Satisfaction with Life Scale (SWLS).  SWLS was developed by Diener et al. [42] It is a brief five-item instrument designed to measure the concept of life satisfaction, with each item rated on a seven-point Likert scale, ranging from 1 (Strongly disagree) to 7 (Strongly agree). According to Kobau et al.[43], SWLS demonstrated acceptable internal consistency reliability (Cronbach’s α = 0.88).

Data Analysis And Results

Assessment of Measurement Items

Common method bias was examined using the Harman’s one-factor test to detect the existence of a general factor that accounts for 50% of variance among the measurement items [44]. Both DASS and INQ did not seem to measure a single dimension. Additionally, DASS, INQ, and SWLS use 4-point, 5-point, and 7-point Likert-type response scales respectively to treat the effects of common method bias.    

The measurement analysis was included as a common practice for the social science studies. Reliability is a test of how consistently a measuring instrument measures whatever concept it is measuring in this context; thus, exploratory factor analysis was applied to assess the measurement items as suggested by Sekaran & Bougie [45]. We assessed the measurement items to make sure the items are reliable in the context of the study.

Next, exploratory factor analysis was applied to assess the measurement items. The principal component analysis using Varimax rotation method ensured that the items load on corresponding factors. The results of the factor analysis satisfied Kaiser-Meyer-Olkin Measure of Sample Adequacy (KMO-MSA) at a value above 0.5 [46] and Bartlett’s Test of Sphericity, which rejected the null hypothesis that the correlation matrix is an identity matrix.

The reliability analyses were used to assess the consistency of items in measuring the concept they set out to measure. Table 2 presents the descriptive and reliability statistics, where Cronbach’s alpha coefficient for all the variables were within the range of 0.847 to 0.952, which is well above the value of 0.70 recommended by Nunally [47]. No items were deleted to improve the internal consistency of the variables being studied. Mean score was used for interpretation of score.  Although the mean value for anxiety for both sexes is similar, male participants appeared to report a slightly higher mean value for depression (M = 1.94, S.D. = 0.69) and stress (M = 2.11, S.D. = 0.79). Female participants appeared to score higher for thwarted belongingness (M = 2.78, S.D. = 0.83). These results are similar to past research which found male students to report more severe depressive symptoms compared to female students. The independent-samples t-tests showed that only SWL appeared to be significantly different statistically across sex, where male participants reported a lower mean score compared to female participants (Table 2).  

Table 2. Descriptive and reliability statistics of participants 

Note: * Significant difference between male and female participants. 

Hypotheses Testing

Prior to the hierarchical regression analysis, the Pearson’s product moment correlation was applied to examine the association between the variables. Table 3 shows that the strength of correlation between the independent variables, namely depression, anxiety, and stress, are strong and statistically significant at r ≥ 0.60. Moreover, the independent variables appear to have stronger correlations with perceived burdensomeness than thwarted belongingness, and reported weak but statistically significant negative correlations with SWL.

Table 3. Correlation between variables

Significant levels: ** p < 0.01, * p < 0.05,

The moderating effects of perceived burdensomeness and thwarted belongingness were tested using a four-step hierarchical regression analysis as recommended by Sharma et al. [48, 49]. Step 1 tested the effect of sex as the control variable and it accounted for 2.3% of variance in SWL (β = -0.15, p < 0.01). Step 2 tested the effects of depression, anxiety, and stress (Hypotheses 1 to 3), where only depression accounted for 9.9% of variance in SWL. Anxiety and stress were not found to be significant predictors and hence, Hypotheses 2 and 3 are not supported.

Step 3 examined the inclusion of moderator variables (perceived burdensomeness and thwarted belongingness) as independent variables—Table 4 presents the regression analyses for perceived burdensomeness (left column) and thwarted belongingness (right column). The F change value was not significant with the inclusion of perceived burdensomeness to the structural path, but F change was significant with the inclusion of thwarted belongingness, which accounted for 4.7% of variance in SWL (β = 0.23, p < 0.01). Based on Sharma et al., [48], we proceeded with Step 4 which tests Hypotheses 4 and 5 by including the product of the independent variables and moderator variables as predictors of SWL. The interaction between depression and perceived burdensomeness (β = 0.76, p < 0.01), and the interaction between anxiety and perceived burdensomeness (β = 0.79, p < 0.01) contributed 16.0% of variance in SWL, thus partially supporting Hypothesis 4 (pure moderator). For thwarted belongingness, only stress (β = 0.73, p < 0.01) appeared to be a significant predictor, contributing 17.0% of variance in SWL, thus partially supporting Hypothesis 5 as quasi moderator.

Table 4. Hierarchical regression analysis: The moderating effect of perceived burdensomeness and thwarted belongingness 

Significant levels: ** p < 0.01, * p < 0.05

The post hoc graphs are developed only for interactions that are statistically significant in the fourth step of the hierarchical regression analysis (refer to Table 4). This step helps visualise the relationship between depression, anxiety, and stress with SWL under the moderating influence of perceived burdensomeness and thwarted belongingness. Figure 2 (i & ii) show that participants who scored lower than the mean average for perceived burdensomeness would experience lower SWL when they experience greater depression or anxiety. On the contrary, the relationship appears positive when perceived burdensomeness was rated higher than mean average.

Figure 3 presents the negative linear relationship between stress with satisfaction in life among participants with low or high thwarted belongingness. The solid line represented a group of participants who scored lower than the mean average for thwarted belongingness whereas the dashed line represented the other group of participants who scored higher than the mean average for thwarted belongingness. Higher stress translates to lower satisfaction in life for both groups of participants. The negative relationship appears to be stronger for the group with higher thwarted belongingness.

Discussion

The results of the stepwise hierarchical regression analyses presented in Table 4 showed that only depression predicted SWL even though all three exogenous variables, namely depression, anxiety, and stress, were negatively correlated with the SWL. The results also suggested interpersonal needs (perceived burdensomeness and thwarted belongingness) to be moderating variables that could potentially reduce or raise SWL among young adults.

With reference to Figure 2, the slopes indicate that individuals who scored low in perceived burdensomeness reported higher SWL compared to those who scored high in perceived burdensomeness. Another observation from the figure is that there is no statistically significant different in satisfaction with life among students who experienced low or high depression and anxiety levels. Based on Steps 3 and 4 of Table 4, perceived burdensomeness exhibited the characteristics of a pure moderating effect, thus suggesting its pivotal role in individuals’ well-being. Our study is one of the few studies that analysed the explanatory role of interpersonal needs in the cognitive component of SWL. Chu et al. found perceived burdensomeness and thwarted belongingness to explain suicidal ideation, a state of mind that is essentially the opposite of SWL [50]. A takeaway from this is that the negative perception of the self as a burden to others is not beneficial towards maintaining one’s well-being and could in fact be harmful. In the United States and in other countries, suicide prevention programmes now focus on the theme “You Matter”, which highlights the importance and significance of developing a sense of belongingness [51]. Counsellors in universities or colleges can incorporate similar themes of self-care in their sessions, with the aims of changing any negative perceptions students might have of themselves.

Figure 3 showed the quasi moderating effect of thwarted belongingness on the relationship between stress and SWL. There is statistically significant different in satisfaction with life among students who experienced low or high stress levels. For both the levels of thwarted belongingness, the simple slopes showed that higher stress contributes to lower satisfaction with life. Figure 3 also explored the said relationship among individuals who scored low or high in thwarted belongingness. Surprisingly, the results showed that individuals who scored high on thwarted belongingness reported higher SWL, compared to individuals who scored low in thwarted belongingness. This is inconsistent with previous literature and a reason to it may be that, due to their desire for independence, young adults might be more inclined to withdraw and isolate themselves from others, gradually reducing their social circles and limiting their ability to seek social support when needed [52]. In addition, today’s generation of young adults are more inclined to interact virtually on online platforms [15], with a desire to escape from the reality with the availability of digital world [53, 54].  They experienced and formed the escapism behaviour by spending long hours on virtual world, developed imagined ideal virtual relationships, but encountered challenges in face-to-face social interaction and relationship and tended to withdraw themselves.

Figure 3 also indicated that individuals facing higher stress reported lower SWL regardless of whether they reported low or high levels of thwarted belongingness. Participants with high levels of thwarted belongingness reported higher SWL compared to those with low levels of thwarted belongingness. This seems to suggest that sense of belongingness does not necessarily contribute to SWL. Higher levels of thwarted belongingness indicate lower sense of belongingness, as one has failed to form close social interactions. Surprisingly, regardless of stress level, individuals who scored high in thwarted belongingness were satisfied with their lives. In addition, these individuals have poorer ability to cope with stress compared to those who scored low in thwarted belongingness. This result is unique in highlighting Generation Z who participated in this study required less face to face social interaction yet they could form an ideal virtual relationship with a lower sense of belongingness context. [53] However, with the increase of online platforms, forming social virtual relationships on digital domains are becoming common for Generation Z and the impacts of this form of relationship remained unknown.

However, our finding is in contrast with some previous research. Civitci [55] found that undergraduate students who participate more in extracurricular activities have higher college belongingness and higher life satisfaction. Similarly, a study by Mellor et al. supported the ‘‘belongingness hypothesis”, suggesting that individuals seek to form long-term, meaningful, and positive relationships and that failure to achieve this contributes to social isolation, loneliness, and suicidal thoughts [56]. As our findings are inconsistent with that of past studies, it is essential to be cautious in drawing conclusions about the relationship between the need for belongingness and SWL.

The study was among the first study which adapted the IPQ and tested in the context of young adults in Malaysia. The findings are imperative as it helps the Malaysian mental help professions to understand that students who are satisfied with life might also experience depression and anxiety too. In addition, university students who experienced stress symptoms were not due to poor ‘interpersonal need’ or lack of sense of belongingness. Other aspects of issues that lead to stress symptoms needs to explore further.

Suggestions for future study and limitations

Our findings highlight the necessity of preventing negative mental conditions and promoting positive mental health in young adults. Prevention activities such as school bullying, students’ educational accomplishment, employment planning activities, and educational transformation were the outcomes of the science of prevention [57]. Universities and colleges can offer more activities, as part of the science of prevention, that focus on students’ mental health. Higher education institutions should actively encourage this agenda of mental health [58] and execute activities that focus on advocating the importance of mental well-being among students.[57]

One method that has been found to benefit mental well-being is the art of mindfulness. Mindful individuals are better able to overcome negative affective outcomes despite experiencing high levels of perceived burdensomeness and thwarted belongingness. A study has suggested mindfulness training to be included as part of clinical intervention [59].^.In academia, mindfulness techniques embedded in class activities, such as movement-based courss (e.g., Taiji quan, Pilates, and GYROKINESIS ®) which include a 15-week class syllabus, showed an increase in mindfulness scores among college students [60]. In addition, mindfulness-based interventions could lessen critical self-evaluation, which may improve self-acceptance and mental well-being [61]. Thus, future studies could investigate the effectiveness of mindfulness training incorporating experimental versus control groups.

It has been found that undergraduates would most likely seek help or emotional support from their friends (79.4%), and least likely from counsellors (7.2%). Only a small proportion of depressed students turn to counselling services and this issue needs to be investigated [62]. Social stigma could be a reason why students avoid seeking professional help. A systematic review done by Clement et al. [63] showed that mental health stigma has a small- to moderate-sized negative effect on individuals seeking help. Many researchers have indicated that students are unwilling to seek help from campus counselling support services because they are concerned about being stigmatised [2, 5] . Other findings have also shown that most young adults would seek help from friends instead of professionals. Friendships are of the utmost importance to young adults and hence, developing a peer support group in school counselling programmes could be an effective way to reduce suicide rates among the youths [64].

Early identification of college students with mental health conditions and comprehensive assessments are critical to provide immediate and adequate services to avoid undesirable outcomes or tragedies [2]. Continued rigorous research on the causes of depression and prevention programmes should be carried out to reduce the incidence rates of undesirable mental health conditions [65].

Finally, this study is not without its limitations. The DASS instrument is not equivalent to clinical diagnosis although DASS has been used and validated in various settings. Although our study reported the positive association between satisfaction in life and thwarted belongingness, we recommend our findings to be interpreted with caution. This finding shall be interpreted with caution and limit the generalisability of the results. Replications of this study in various setting maybe necessary. In addition, self-administered questionnaire was used and may pose risk of social desirability bias. Thus, future studies shall be expanded to broader sampling and include evidences obtained from students’ personal records and data (e.g., Facebook and Instagram posts which may project their state of well-being).

Conclusion

Our study aimed to examine the relationship among depression, anxiety, stress, and SWL among university students in Malaysia. Furthermore, we wanted to determine the moderating effect of interpersonal needs, specifically perceived burdensomeness and thwarted belongingness, on this relationship. Perceived burdensomeness is indeed a significant moderator on the relationship between (i) depression, (ii) anxiety and SWL. On the other hand, thwarted belongingness exerts significant moderating effect on the relationship between stress and SWL.

Interestingly, we found a positive relationship between thwarted belongingness and SWL, which is in contrast to findings from past research. We attribute this unique finding to the fact that our participants are from “Generation Z”, whose lives have been greatly influenced by new technologies. The ways in which they communicate (i.e., through online platforms) and how they garner a sense of belongingness are very different from their older counterparts. At the point of writing, generational variance has not been given enough attention in clinical and teaching settings. We believe the concept of generational differences should be examined further in research and that mental health practitioners as well as teaching staff should be more aware of its effects. This research  lend supports to Ventriglio & Bhugra (2015), who claimed that every, generation has its own way or method of learning and keeping information, and how the young adults of today live and interact among themselves are changing as well [66]. Their idea of life satisfaction or their perspective on life might be different from college students of earlier generations. Our research sets the stage for future researchers to investigate mental health conditions further, particularly among Generation Z college and university students. Han et al. [67] and Kovess-Masfety et al. [68] also recommended that future studies on mental health conditions to include non-college attending young adults. In addition, future studies could consider other control variables that may act as predictors to life satisfaction (e.g., quality of intimate relationships, attachment style, academic performance).  

Abbreviations

DASS: Depression, Anxiety, and Stress Scale; KMO-MSA: Kaiser-Meyer-Olkin Measure of Sample Adequacy; INQ: Interpersonal Needs Questionnaire; M: Mean; S.D.: Standard deviation; SWL: Satisfaction with Life Scale

Declarations

Acknowledgement:

We thank Ms. Neeta S. Singh and Ms Sarah Loh Wai Yin for their professional proof reading and editing services; Ms. Neerushah Subarimaniam for providing constructive feedback, Ms Tan Wei Tong and Ms Chloe Kwok Wei Yan for their contribution during data collection period.

Authors’ contributions:

KSK originated the design of the study, collected data, performed statistical analysis. KSK, TCC and OPB interpreted and drafted the manuscript. KSK, TCC and OPB critically revised the draft manuscript. All authors have read and approved the final manuscript

Funding:

The author(s) received no financial support for research, authorship, and/or publication of this article.

Availability of data and materials

The generated dataset is available upon request to the corresponding author at the contact address in this article.

Ethics Approval and Consent to Participate:

Written informed consent was obtained from participants who took part in the study and Sunway University Research Ethics Approval was obtained (SUREC 2018/044). This article does not contain any studies with animals.

Consent for publication:

Not applicable.

Competing interests:

All authors declare no conflict of interest.

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