Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jun 19, 2025; 15(6): 106451
Published online Jun 19, 2025. doi: 10.5498/wjp.v15.i6.106451
Prevalence and risk factors of depressive and anxiety symptoms and functional constipation among university students in Eastern China
Bo-Chen Jiang, Jing Zhang, Man Yang, Hai-Dong Yang, Xiao-Bin Zhang
Bo-Chen Jiang, Department of Clinical Medicine, Shandong University, Ji’nan 250012, Shandong Province, China
Jing Zhang, Man Yang, Hai-Dong Yang, Department of Psychiatry, The Fourth People’s Hospital of Lianyungang, The Affiliated Kangda College of Nanjing Medical University, Lianyungang 222003, Jiangsu Province, China
Jing Zhang, Department of Medicine, Yangzhou University, Yangzhou 225003, Jiangsu Province, China
Hai-Dong Yang, Xiao-Bin Zhang, Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, Suzhou 215137, Jiangsu Province, China
Co-corresponding authors: Hai-Dong Yang and Xiao-Bin Zhang.
Author contributions: Jiang BC and Yang HD wrote the manuscript and performed the statistical analysis; Yang HD and Zhang XB designed the research study; Jiang BC, Zhang J, and Yang M collected the data, coordinated with schools, and maintained the online survey platform; all authors have read and approved the final manuscript.
Supported by Suzhou Clinical Medical Center for Mood Disorders, No. Szlcyxzx202109; Suzhou Key Laboratory, No. SZS2024016; Multicenter Clinical Research on Major Diseases in Suzhou, No. DZXYJ202413; and General Program of Lianyungang Health Committee, No. 202336.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Fourth People’s Hospital of Lianyungang, No. 2023 LSYYXLL-P21.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts with any financial interests.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Bin Zhang, Academic Editor, Professor, Department of Psychiatry, Suzhou Psychiatric Hospital, Institute of Mental Health, The Affiliated Guangji Hospital of Soochow University, No. 11 Guangqian Road, Xiangcheng District, Suzhou 215137, Jiangsu Province, China. zhangxiaobim@163.com
Received: February 27, 2025
Revised: April 4, 2025
Accepted: April 24, 2025
Published online: June 19, 2025
Processing time: 92 Days and 4.1 Hours
Abstract
BACKGROUND

Depression and anxiety are prevalent among university students worldwide, often coexisting with functional constipation (FC). Family relationships have been identified as crucial factors affecting mental health, yet the gender-specific associations between these conditions remain underexplored.

AIM

To assess prevalence of depressive symptoms, anxiety symptoms, and FC among Chinese university students and explore their associations.

METHODS

Using a cross-sectional survey design, data were collected from 12721 students at two universities in Jiangsu Province and Shandong Province. Depressive symptoms were assessed using the Patient Health Questionnaire-9, anxiety symptoms using the Generalized Anxiety Disorder-7 scale, and FC using the ROME IV. Gender-stratified analyses and population attributable risk proportions were calculated to evaluate risk factor patterns and population impact.

RESULTS

The prevalence of self-reported depressive, anxiety, and comorbid depressive and anxiety symptoms was 16.3%, 24.9%, and 13.3%, respectively, whereas that of FC was 22%. Students with depressive symptoms were 1.811 times more likely to have FC than those without. Female gender, parental relationships, and lower household income were significant risk factors for both mental health conditions. For depressive symptoms, females experienced stronger effects from both parental conflict [odds ratio (OR) = 8.006 vs OR = 7.661 in males] and FC (OR = 1.954 vs OR = 1.628 in males). For anxiety symptoms, conflicted parental relationships had stronger effects in males (OR = 5.946) than females (OR = 4.262). Overall, poor parental relationships contributed to 38.6% of depressive and 33.5% of anxiety symptoms.

CONCLUSION

Family relationships significantly impact student mental health, with gender-specific patterns. Targeted interventions addressing family dynamics could reduce mental health burden in university settings.

Keywords: University students; Depression; Anxiety; Functional constipation; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7

Core Tip: This study reveals gender-specific associations between mental health and functional constipation (FC) among Chinese university students. In a large-scale survey of 12721 students, females showed greater vulnerability to parental conflict for depressive symptoms and stronger associations between FC and depression, while males demonstrated higher susceptibility to parental conflict for anxiety symptoms. The study quantifies, for the first time, the substantial population impact of poor family relationships, contributing to 38.6% of depressive and 33.5% of anxiety, providing evidence for gender-differentiated family-based intervention strategies.