A total of 10676 college/university students were included in this study and the prevalence of mental disorder was 21.4%. Although this result was lower than the finding (28.0%) from a survey conducted in Finnish university students, it was a little higher than results of a cross-national mental health survey (20.3%) and another one (19.0%) from Hungary, all above studies were conducted among college students using the GHQ-12. These differences might be attributed to racial, cultural diversities, and socioeconomic disparities[23, 24]. With the increase of SSQ, the risk of being mental disorder among college students showed a significant decreasing trend. It suggested that improving the SSQ could be an effective and practical method to prevent and treat mental disorders of college students.
The high prevalence of psychiatric disorder in college/university might due to the fact that most of the students were just entering adulthood, it was a crucial time for personal identity development. In this period, they were generally sensitive to the shift of surroundings, such as changes in living environment and learning style, crisis of interpersonal relationships, which was easily to cause psychological fluctuations and mental problems[25, 26]. Another possible explanation was that entering college/university followed by a series of unexpected challenges for many students. Apart from considerable pressure related to academic load, they had to bear more adult-like responsibilities, even though they had not yet captured enough cognitive maturity and developed foundational skills required for adulthood. For example, college students might face with stresses from living with housemates with different lifestyles or personalities, graduating and looking for work, and dealing with love affairs. All of these might induce psychological problems, which were harmful to their health, academic performance, and even individual development. Therefore, free psychological counseling centers were suggested to set up in campus, so that more professional resources could be offered to help students prevent and resolve psychological problems.
Students’ mental disorder was associated with various factors. Similar to previous studies, gender was one of important factors influencing college students’ mental health in our study, as the female generally lived with more delicate emotions and were prone to have negative views of their health than males, they were more likely to have mental problems. Compared with the older college students, the freshmen, mostly aged 18-21, faced confused lifetime planning, cash-strapped living, and less social experience, which made them anxious and stressful. Mother played a pivotal role in the development of children’s mental health, but we found mother with college degree or above was a risk factor for students’ mental health. Higher academic degree generally corresponded to longer work time and heavier work stress, which deprived the time and energy to accompany with children. In this case, mothers might ignore mental problems in their children and delay their psychological counseling. In addition, students who drank alcohol tended to have decreased sensitivity, intense emotions, and interpersonal conflicts, and eventually increased the risk of bad mood[31, 32]. Nevertheless, the function between alcohol drinking and mental problem could be bi-directional, college students also opted to cope with their depression, stress and other mental illnesses by drinking.
Higher family economic status could protect students from being mental problems, which aligned with previous evidences that poorer family economic status was associated with lower quality of life and less warmth from parents. Coupled with the increasing self-esteem of college students, the gap between subjective demands and objective facts contributed to psychological imbalance and ultimately induced mental problem. Students followed regular work-rest schedule had significant lower risk of mental disorder than those who never/seldom work-rest regularly. This finding was partly supported by a study based on the UK Bio-bank that circadian disruption was reliably associated with various adverse mental health outcomes. However, as its study sample aged 37-73 years old, the result might be not applicable for college students, further prospective studies and random controlled trials were needed to confirm their relationship. Correspondingly, sleep seven hours and longer would decline the risk of mental disorder, which was supported by a recent meta-analysis. Adequate sleep could preserve the homeostasis of affective brain, and optimally prepare next-day emotional functioning, leading to a stable and healthy mental status.
Compared with low SSQ, moderate and high SSQs were protective factors for students’ mental health. From the correlation coefficient matrix analysis, we found that SSQ and its subscales were negatively correlated with mental disorder, which were in consistent with previous studies. Under different levels of adjustment, medium and high SSQs and their subscales were all negatively associated with mental disorder when compared to low SSQ. Adequate high-quality social supports could give individuals comfortable mental consolation and the sense of security, which benefited college students to keep a healthy psychological status. In general, family was the most important source of social support, followed by friends and significant others. Because of the conservative family values and collectivist nature of Chinese society, family ties were deemed as the most important social relationships. Generally, people affiliated with mental disorder often create the feelings of stigma or shame. In this case, the family should play a key role in guiding family members with psychological problems to receive treatment, and making patients healthy through active interventions. However, several studies listed friends as the most important source of supports, ahead of family and significant others. The reason might be that most college students lived with friends in the campus rather than their family members, friends could timely find psychological change of each other and social supports from friends could offer sufficient mental assistance. Finally, multinomial logistic regression analyses suggested that SSQ could improve college students’ mental health, regardless of from family, friends or significant others. This result informed that university administrators and teachers should strive to improve students’ SSQs, especially the supports from family and friends, so as to prevent and treat mental problems in college students better.
Strengths and limitations
There were several strengths in this study. Firstly, we included 10,676 students in this study via the multi-stage random cluster sampling. It was a big sample size among relevant studies, guaranteeing the results were credible to some extent. Secondly, we obtained some important findings. For example, there was a decreasing trend of being mental problem with the improvement of SSQ. This result further supplemented and determined the influencing factor network of college students’ mental health, and provided statistical data for international comparisons around this topic.
However, some limitations also should be acknowledged. Firstly, the study was cross-sectional design, the results only suggested the observational correlation rather than the exact causality between SSQ and mental health. Secondly, students’ SSQs and mental health statuses were collected through self-reported, which might be a potential source of information bias. However, as the questionnaire was filled out in anonymous forms, obtained data might be objective. Furthermore, previous studies also suggested that there was qualified agreement between online self-reported and measured data , indicating the bias derived from this method were permissible. Thirdly, this study was conducted in Wuhan city, which might limit the generality to other regions. However, college students in Wuhan were from across the country, which could make up for the lack of sample representation to some extent.