Mental health serves as an integral component of overall health and well-being, and plays an important role in maintaining physical health. Previous studies also found that adverse physical health status (e.g., obesity, asthma, skin diseases, hepatitis, heart diseases) had an impact on mental health in young people and adults [1
]. As part of mental health, emotional well-being incorporates happiness, interests in life, satisfaction and quality of life [6
], and the ability to recognize, express and regulate one’s emotions [9
]. Negative emotions often manifest as depression, anxiety, irritability, excitement, etc. The widely recognized Depression Anxiety Stress Scales-21 (DASS-21) is an effective measure of negative emotions in Chinese people [10
]. Depression is typically characterized by melancholy, frustration, and anguish, while anxiety refers to unnecessary tension for objective things and interpersonal relationships; general distress is the common feature for both depression and anxiety [12
]. Indeed, depression, anxiety, and stress are deemed as significant indicators of psychological well-being [13
In the past decades, the number of people suffering from depression and anxiety have increased sharply, which has posed a grave threat to society. Relevant research found that the global aggregate point prevalence of depression was 12.9 percent, by combining the data of over 1 million participants from 30 countries between 1994 and 2014. South America had the highest depression rate, reaching up to 20.6 percent, followed by Asia (16.7%), North America (13.4%), Europe (11.9%), Africa (11.5%), and Australia (7.3%) [14
]. Meanwhile, depression and anxiety problems are more prevalent among college students [15
]. A meta-analysis study indicated that the worldwide prevalence of depression among medical students was 34.0 percent, with the highest proportion reported in Asia at 43.0 percent [18
]. Another related study showed that in Asia, 11.0 percent of college students suffered from depression, while the aggregate prevalence of anxiety disorders was 7.04 percent [19
]. In China, college students have become psychologically disadvantaged, with roughly one-fifth of students struggling with different levels of mental problems, and a considerable number of students experiencing depression, anxiety, and stress [20
College is a crucial period of life for students to shape proper values, worldviews, outlooks of life, and resilience [21
]. This period, in some cases, is defined as the final stage of adolescence. Adolescence is the phase of life stretching between childhood and adulthood, and rather than referring to the 10–19 age group, a definition of adolescence as 10–24 years old corresponds more closely to popular understandings of this life stage [22
]. College students’ mindset not only determines their academic achievement in school, but also predicts their adaptability to the workplace and society in the future. Therefore, it is of great significance to clarify the influencing factors and mechanism of college students’ psychological well-being in various backgrounds. College students’ emotional well-being was significantly correlated with their monthly household income [13
], ethnicity [13
], social life [13
], parental education and occupations [23
], interests in major [25
], hometown [23
], body image [23
], female sex [23
], age [23
], socioeconomic circumstance [23
], academic performance [26
], the pressure to succeed [26
], post-graduation plans [25
], and financial difficulties [27
]. Additionally, some studies found that college students were confronted with multiple kinds of pressure from role changes, study tasks, interpersonal relationships, employment, etc. [30
]. If this pressure is not relieved in time, this emotional suppression can easily lead to mental disorders. In turn, these negative emotions may affect students’ physical health, academic performance, learning efficiency, as well as lifestyle, or even provoke social isolation and misbehavior [32
]. Worse still, mental illness stigma hinders students from seeking psychiatric help, which undoubtedly exacerbates their psychological well-being problems [15
Most of the previous studies used cross-sectional data, while some research employed longitudinal designs to study college students’ psychological well-being status, as well as its determinants, in different years. Globally, Puthran et al. (2016) found that medical freshman students had the highest rates of depression at 33.5 percent, which then experienced a significant decline over time to 20.5 percent before graduation [38
]. A similar changing trend was witnessed in the context of the United Kingdom. Bewick et al. (2010) pointed out that compared to the pre-university stage, students struggled with the highest levels of strain in the first semester of year one; and there was a significant reduction in levels of distress from semester one to semester two in both the first and third years [39
]. Andrews & Wilding (2004) found that 36 percent of previously depressed or anxious students had recovered [27
]. Nevertheless, studies in the United States reached the opposite conclusion; that the psychological well-being of students seemed to worsen over time. Beiter et al. (2015) found that compared with freshmen, juniors and seniors scored higher on depression, anxiety and stress scales [26
]. Likewise, Rosal et al. (1997) concluded that students’ psychological status resembled that of the general population upon enrolment, but their depression scores experienced a persistent rise over time [40
In general, existing literature regarding the psychological distress of college students mainly used cross-sectional data, and the few longitudinal studies often had a small sample size, with participants mostly from a single university. Thus, there is a dearth of detailed analysis and comparisons of the mental health status of college students over the four-year span, especially in a Chinese context. Indeed, college students of different years may be exposed to different learning circumstances and experience various degrees of depression, anxiety, and stress. It is critical for colleges to understand students’ emotional changes in order to offer proper guidance and support. On this base, our study followed a cohort of undergraduates from 15 Chinese universities; using descriptive statistics and multiple group analysis, we pictured the changing trends of students’ negative emotions during their four academic years in college.
Generally, Chinese college students experienced more mental problems in the freshman and sophomore years. For freshman students, their anxiety may be partly caused by adjustment disorders, especially when students are separated from their parents and friends and have to orient themselves to new environments. Moreover, given the curriculum organization in Chinese universities, which usually set general courses in the first year and introduce more specialized courses from the second year, sophomores may be confronted with intense pressure from study compared to the previous semesters. This may inevitably lead to higher stress and even depression. Our conclusion partly echoed another similar study conducted in the UK, which indicated that once students started university, a great strain was placed on their well-being, with a significant reduction in levels of distress from semester one to semester two being observed in both year one and year three [40
]. However, the study in the UK considered university a time of heightened distress, while in China the average DASS scores only indicated certain anxiety problems among college students. We suppose that this disparity can mainly be credited to financial concerns. Previous studies showed that financial pressure was a significant negative linear predictor of psychological health [26
], and students who dropped out due to financial burden tended to have poor mental and physical health [28
]. Therefore, financial difficulties should be deemed as one major source of negative emotions. We take institutional and cultural aspects into account when analyzing the differences in financial pressures on Chinese and British students. From an institutional perspective, Chinese college students usually pay much lower tuition for undergraduate study compared to their counterparts in the UK; meanwhile, the economic aids in China are relatively more accessible regarding both its simpler application process and also its better chance of success. From a cultural perspective, Chinese parents are more commonly seen to pay the costs of higher education of their children, while UK students have to bear the financial burden mostly by themselves.
In addition, the changing trend of students’ psychological well-being in China differs from that in the US. In China, the psychological health of freshmen and sophomores deserves more attention. By contrast, in the US, juniors and seniors scored higher on depression, anxiety, and stress scales compared with freshmen, and students’ top three concerns were academic performance, the pressure to succeed and post-graduation plans [25
]. A possible reason behind this difference is that most Chinese universities have strict requirements for students’ national college entrance examination scores, while in the US, college students face intense pressure on meeting graduation requirements, rather than admission thresholds. Therefore, during college, American students need to cope with relatively higher academic stress than Chinese students.
Previous literature on college students’ psychological well-being was generally based on cross-sectional data, so the measurement may not be consistent when comparing students in different years. Our study, using longitudinal data, helps to strengthen the credibility of relevant conclusions. By tracking the same cohort over four years, we confirmed that there were significant differences for students in different years. We attribute the psychological disparity to grade differences, rather than the inapplicability of DASS-21 scale across years, for mainly two reasons. First, the DASS-21 enjoys worldwide recognition in measuring levels of depression, anxiety, and stress, so we assume that it can be applied to examine students in different years [50
]. Second, we tracked the same group of students for four years during college and measured their mental state with the same psychological well-being scales. Therefore, the differences in the measurement results indicated that students’ mental status experienced changes over time.
The primary purpose of this study was to examine whether there were differences in the psychological well-being status of Chinese college students as they experienced university life. Through descriptive statistics and multiple group analysis, we can mainly draw the following conclusions.
First, Chinese college students were on average mentally healthy with regards to stress and depression, but they suffered from anxiety beyond normal levels in the first three years.
Second, approximately 20 to 40 percent of college students suffered from different degrees of depression, anxiety, and stress. This was consistent with some relevant previous research, which concluded that roughly one-fifth of students struggled with different levels of mental health problems.
Third, it has been confirmed that there was a disparity in the psychological well-being of students in different years. To be more specific, the highest average scores of depression, anxiety, and stress appeared either in the first or second year. A relatively large ratio of freshmen suffered from anxiety, while, during their sophomore year, students tended to experience more stress and depression. There were significant differences between sophomore, junior and senior students, showing that their mental health situation had improved over time.
Based on the results of this study, we suggest that colleges and universities should provide students with tailored psychological guidance, considering that college students in different years may have differentiated psychological well-being status. Universities may offer proper psychological counseling for freshman students in order to relieve their anxiety and pay special attention to improving the psychological well-being of sophomore students. Furthermore, it is worth noting that the overall optimistic situation of the psychological state of colleges students may be due to their weak perception about changes in their external social environment. In the future, we could study college students’ mental changes after entering the labor market for a certain period. The comparison of their psychological situation at work and during college could be explored to offer more implications on the development of psychological well-being counseling programs in college.