Association Between Mental Health Literacy And Anxiety And Depressive Symptoms Among College Students

BackgroundThe period of college students is a critical period from adolescence to adulthood.The immature psychological state,the change of social role and the increase of pressure make college students more prone to psychological problems such as anxiety and depressive symptoms.In recent years,studies have found that the detection rate of anxiety and depressive symptoms among college students is high.Anxiety and depressive symptoms will not only affect the subjective quality of life of college students,but also easily lead to negative events such as suicidal ideation or behavior,causing irreparable damage to family,country,and society.Mental Health Literacy,as an important part of Health Literacy,refers to"knowledge and beliefs that help individuals to identify,prevent,and cope with mental disorders" and can be used to identify,prevent,and cope with mental disorders related diseases,mainly based on mental health knowledge and community attitudes toward mentally ill.At present,the research subjects are mainly concentrated on residents and medical workers,and there are few researches on college students at home and abroad.Studies have found that the mental health literacy level among college students is generally not high.Studies have found that although the prevalence rates of mental health problems among college students are high,the proportion of students who are aware of early mental health symptoms and seek help from professionals or institutions is low.Researchers have revealed that mental health literacy may affect college students seeking psychological help.Improving mental health literacy may contribute to the early identification of mental health problems and may be an effective strategy to reduce the stigma of mental illness and increase help-seeking behavior.At present,there is no research on the association between mental health literacy and anxiety and depressive symptoms among college students at home and abroad.By investigating the current state of mental health literacy and anxiety and depressive symptoms among college students,this study analyzed the associated factors of anxiety and depressive symptoms and association between mental health literacy and anxiety and depressive symptoms among college students.It can provide theoretical support for further targeted mental health education,in order to improve mental health literacy and mental health among college students.Objectives1.To understand the mental health literacy level among college students,including:the mental health knowledge and community attitudes toward mentally ill among college students;2.To understand the prevalence rates and associated factors of anxiety and depressive symptoms among college students;3.To analyze the association between mental health literacy and anxiety and depressive symptoms among college students.MethodsA cross-sectional study was conducted in three comprehensive universities in Jinan,Shandong Province from November 2020 to January 2021.The subjects were full-time undergraduates from freshman to senior in three universities.In this study,mental health literacy and psychological status questionnaires were used to collect information.Questionnaires consist of three parts:basic demographic information,mental health literacy level(mental health knowledge level,community attitudes toward mentally ill),and psychological status(anxiety and depressive symptoms).Questionnaires were filled online through the Questionnaire Star.It took an average of 15 minutes to complete entire questionnaires.This study was approved by the research ethics boards of School of Public Health,Shandong University.SPSS 24.0 was used for data processing and statistical analysis.Chi-square test,t test and U test were used to compare the data characteristics.The trend chi-square test was used to analyze the linear relationship between mental health knowledge,community attitudes toward mentally ill and anxiety and depressive symptoms.The association between mental health literacy and anxiety and depressive symptoms among college students was analyzed by unconditional logistic regression.Values of P<0.05 were considered statistically significant.Results1.Basic demographic information of subjectsThere were 3175 subjects with an average age of 19.6±1.3 years.Among them,1477(46.5%)were male and 1698(53.5%)were female.2.Mental health literacy among college studentsThe M(P25,P75)of the Mental Health Knowledge Questionnaire(MHKQ)scores were 17(16,18).The awareness rate of mental health knowledge among college students was 84.7%.Across genders,rates significantly differed,with males’ mental health knowledge rates at 83.2%,and females’ mental health knowledge rates at 86.1%(χ2=101.85,P<0.001).The M(P25,P75)of the Community Attitudes toward Mentally Ill(CAMI)scores were 141(133,148).The M(P25,P75)of CAMI scores among male students were 139(131,147)and that of female students were 142(136,150),and the difference was statistically significant(Z=-9.06,P<0.001).3.Anxiety and depressive symptoms among college studentsThere were 1257 students with anxiety symptoms,accounting for 39.6%of the total students,of which 8.8%had mild anxiety symptoms,18.4%had moderate anxiety symptoms,5.7%had severe anxiety symptoms,6.7%had extreme anxiety symptoms.There were 817 students with depressive symptoms,accounting for 25.7%of the total students,of which 9.5%had mild depressive symptoms,11.2%had moderate depressive symptoms,2.9%had severe depressive symptoms and 2.1%had extreme depressive symptoms.There were 707 students with comorbidity of anxiety and depressive symptoms,accounting for 22.3%of the total students.4.Associated factors of anxiety and depressive symptoms among college studentsMulti-factor analyses showed that college students who were females,science and technology majors,medicine majors,seniors,with poor family economic status,fair or poor physical health,fair or poor sleep quality,occasional or frequent alcohol consumption in the last year,and poor academic performance were associated with a higher risk of anxiety symptoms.College students who were females,medicine majors,juniors,seniors,with poor family economic status,fair or poor physical health,fair or poor sleep quality,occasional or frequent alcohol consumption in the last year,without boyfriend or girlfriend,fair or poor academic performance,and not participate in extracurricular activities on campus were associated with a higher risk of depressive symptoms.College students who were females,non-only children,medicine majors,juniors,seniors,with poor family economic status,fair or poor physical health,fair or poor sleep quality,occasional or frequent alcohol consumption in the last year,without boyfriend or girlfriend,fair or poor academic performance,and not participate in extracurricular activities on campus were associated with a higher risk of comorbidity of anxiety and depressive symptoms.5.Association between mental health literacy and anxiety and depressive symptoms among college studentsAccording to the quartile of MHKQ scores,mental health knowledge level was divided into four groups.0～16 scores were divided into Q1 group,17 into Q2 group,18 into Q3 group,and 19～20 into Q4 group.According to the quartile of CAMI scores,the community attitudes toward mentally ill were divided into four groups.0～133 scores were divided into Q1 group,134～141 into Q2 group,142～148 into Q3 group,and 149～200 into Q4 group.The results of trend chi-square test showed that from the Q1 group(0～16)to Q4 group(19～20),the proportion of anxiety symptoms decreased with the gradual improvement of mental health knowledge level(χ2 trend=36.13,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with mental health knowledge level in the Q3 group(18)(OR=0.79,95%CI:0.63～0.98)and Q4 group(19～20)(OR=0.67,95%CI:0.54～0.83)were associated with a lowered risk of anxiety symptoms,compared with and Q1 group(0～16).The results of trend chi-square test showed that from the Q1 group(0～133)to Q4 group(149～200),the proportion of anxiety symptoms decreased with the gradual improvement of the community attitudes toward mentally ill(χ2 trend=24.04,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with the community attitudes toward mentally ill in the Q3 group(142～148)(OR=0.70,95%CI:0.56～0.88)and Q4 group(149～200)(OR=0.67,95%CI:0.53～0.84)were associated with a lowered risk of anxiety symptoms,compared with and Q1 group(0～133).The results of trend chi-square test showed that from the Q1 group(0～16)to Q4 group(19～20),the proportion of depressive symptoms decreased with the gradual improvement of mental health knowledge level(χ2trend=48.61,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with mental health knowledge level in the Q3 group(18)(OR=0.66,95%CI:0.52～0.85)and Q4 group(19～20)(OR=0.58,95%CI:0.45～0.74)were associated with a lowered risk of depressive symptoms,compared with and Q1 group(0～16).The results of trend chi-square test showed that from the Q1 group(0～133)to Q4 group(149～200),the proportion of depressive symptoms decreased with the gradual improvement of the community attitudes toward mentally ill(χ2趋势=38.89,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with the community attitudes toward mentally ill in the Q3 group(142～148)(OR=0.63,95%CI:0.49～0.81)and Q4 group(149～200)(OR=0.55,95%CI:0.42～0.71)were associated with a lowered risk of depressive symptoms,compared with Q1 group(0～133).The results of trend chi-square test showed that from the Q1 group(0～16)to Q4 group(19～20),the proportion of comorbidity of anxiety and depressive symptoms decreased with the gradual improvement of mental health knowledge level(χ2 trend=41.70,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with mental health knowledge level in the Q3 group(18)(OR=0.66,95%CI:0.50～0.85)and Q4 group(19～20)(OR=0.62,95%CI:0.48～0.81)were associated with a lowered risk of comorbidity of anxiety and depressive symptoms,compared with and Q1 group(0～16).The results of trend chi-square test showed that from the Q1 group(0～133)to Q4 group(149～200),the proportion of comorbidity of anxiety and depressive symptoms decreased with the gradual improvement of the community attitudes toward mentally ill(χ2 trend=32.69,P<0.001).Logistic regression analysis showed that,after adjusting for confounding factors,college students with the community attitudes toward mentally ill in the Q3 group(142～148)(OR=0.67,95%CI:0.51～0.86)and Q4 group(149～200)(OR=0.56,95%CI:0.43～0.74)were associated with a lowered risk of comorbidity of anxiety and depressive symptoms,compared with Q1 group(0～133).Conclusions1.The awareness rate of mental health knowledge among college students was 84.7%,and the mental health knowledge level among female students was higher than that among male students.The community attitudes toward mentally ill among college students needed to be improved.Female students had a better community attitudes toward mentally ill than male students.2.The prevalence rates of anxiety symptoms,depressive symptoms and comorbidity of anxiety and depressive symptoms were higher among college students.Anxiety symptoms,depressive symptoms,comorbidity of anxiety and depressive symptoms among college students were associated with many factors,and college students who were females,medicine majors,seniors,with poor family economic status,fair or poor physical health,fair or poor sleep quality,occasional or frequent alcohol consumption in the last year,poor academic performance were associated with a raised risk of anxiety symptoms,depressive symptoms,comorbidity of anxiety and depressive symptoms.3.This study found that mental health literacy was associated with anxiety symptoms,depressive symptoms,comorbidity of anxiety and depressive symptoms among college students.College students with higher mental health literacy level reported lower levels of anxiety symptoms,depressive symptoms,comorbidity of anxiety and depressive symptoms.