The Interaction Of Negative Life Events And Mental Health Literacy On Emotional Symptoms Among College Students

ObjectiveTo explore the interaction between negative life events and mental health literacy(MHL)on emotional symptoms such as depressive,anxiety and stress symptoms in college students,and to provide theoretical basis and new research perspective for reducing mental health problems among college students.MethodsFrom November 2021 to June 2022,a cluster sampling method was adopted to select all freshmen from two colleges in Anhui Province.Baseline survey(T0)in November 2021,and 5 279 questionnaires were collected.Then,a follow-up survey(T1)was conducted half a year later,and a total of 4 829 questionnaires were collected,with an effective response rate of 91.5%.The Adolescent Self-Rating Life Events Check-list(ASLEC),the Adolescent Mental Health Literacy Assessment Questionnaire(AMHLAQ)and the short-form version of the Depression Anxiety Stress Scales-21(DASS-21)were used to evaluate the level of negative life events,MHL and depressive,anxiety and stress symptoms,respectively,in college students.Independent-samples t test,one-way ANOVA analysis(continuous variable)or Chi-Squared test(categorical variable)and rank-sum test were used to compare MHL,negative life events and depressive,anxiety and stress symptoms in college students among different groups.We used Logistic regression analysis to compute the parameter estimates and covariance matrix.EXCEL table prepared by Andersson et al was used to calculate the relative excess risk,attributable proportion synergy index of interaction and 95%CI to evaluate the additive interaction.The relationships between the various influencing factors were investigated by Logistic regression models and incorporated into the product terms to analyze the multiplicative interaction between variable.ResultsThe average age of 4 829 respondents was(18.44 ± 0.88)years,including 2 015males(41.7%)and 2 814 females(58.3%).The overall scores of MHL,knowledge,recognition,attitude and practice were(82.77 ± 11.75),(22.87 ± 3.19),(18.44 ± 3.39),(24.36 ± 3.34)and(19.63 ± 2.74),respectively.The median and interquartile scores of negative life events and emotional symptoms of depression,anxiety and stress were33.00(29.00,42.00),4.00(0.00,10.00),4.00(0.00,10.00),and 4.00(0.00,12.00),respectively.The detection rates of high and low level negative life events were49.2%(n = 2,376 cases)and 50.8%(n = 2,453)respectively,and the detection rates of high and low level MHL were 25.9%(n = 1,252)and 74.1%(n = 3,577)respectively.The detection rates of depressive,anxiety and stress symptoms were27.8%(n = 1,342),34.1%(n = 1,647)and 10.6%(n = 510),respectively.The detection rate of depressive symptoms was higher in college students who were the only child,with better self-rated family economic status,and with drinking.The detection rate of anxiety symptoms in female,higher self-reported family income and drinking were higher than that in corresponding groups.Students who lived urban residence,had high parental education level,high self-reporetd family income and drinking were higher detection rate of stress than those of the corresponding groups.Negative life events and MHL have a positive multiplication interaction on depressive,anxiety and stress symptoms.Taking low levels of negative life events and high levels of MHL as reference,after adjusting the confounding factors,the risks of depressive,anxiety and stress symptoms in students with high level of negative life events and low level of MHL were 2.10,1.85 and 1.93 times higher than those in students with low level of negative life events and high level of MHL.In addition,there was an antagonistic additive interaction between negative life events and MHL on depression,anxiety and stress symptoms.Students with high levels of negative life events and low MHL had the highest detection rates of depressive symptoms(43.5%)and anxiety symptoms(50.8%),the OR = 4.44,95%CI = 3.29 ～ 5.98 and OR = 3.51,95%CI = 2.69 ～ 4.56,respectively.Students who had the same level of MHL,the higher the level of negative life events,the higher the risk of stress.ConclusionThere was an antagonistic additive and a positive multiplicative interaction between negative life events and low MHL on depressive,anxiety and stress symptoms.Therefore,it is necessary to reduce the negative life events in college students and improve their MHL level to prevent and alleviate their mental health problems.