Research paperGender differences in depression, anxiety, and stress among college students: A longitudinal study from China
Introduction
Mental health problems are becoming increasingly common among college students. Relevant research indicated that approximately half of the university students had moderate levels of stress-related mental health concerns, including anxiety and depression (Regehr et al., 2013). In the United States, almost half of college-aged individuals had a psychiatric disorder (Blanco et al., 2008). Likewise, more than 20 percent of Chinese college students suffered from depression and this ratio has kept growing over the past decade (Wei and Sang, 2017; Liu et al., 2019a; b; Luo, 2018). In order to evaluate the mental states of students, the Depression Anxiety Stress Scales (DASS) has been widely acknowledged as a reliable research instrument in this field (Lovibond and Lovibond, 2004), and DASS was also validated to assess psychiatric symptoms in Asians and Chinese population (Quek et al., 2018; Ho et al., 2019). The three scales of depression, anxiety, and stress are considered as sub-dimensions of psychological distress (Lee, 2019).
Gender difference in psychological distress has long been a focus of relevant studies. Previous epidemiological research show that in general, females tend to suffer more from mental problems than males for two reasons. First, the physiological differences between females and males (such as genetic vulnerability, hormone and cortisol levels, etc.) may be reflected emotionally and behaviourally (Hankin and Abramson, 1999). For instance, females and males responded to stress differently as a consequence of their differential sensitivity to events (Afifi, 2007). Females were more vulnerable to stress and pain than males, so they might experience greater sadness and anxiety (Chaplin et al., 2008). Furthermore, self-concepts of traditional masculinity and femininity can affect their attitudes and behaviors towards life experiences. Masculinity exhibits traits such as individualism, and assertiveness, while femininity manifests in affection, compassion, and sensitivity to other's needs (Gibson et al., 2016). The prescribed gender role expectations, in turn, lead to their differential internalizing and externalizing problems. It has been evidenced that women were more likely to struggle with internalizing disorders such as depression and anxiety, while men exhibited more externalizing disorders like substance abuse (Horwitz and White, 1987; Seedat et al., 2009; Rosenfield and Mouzon, 2013), alcohol abuse (Vu et al., 2019) and internet addiction (Zhang et al., 2018). In addition, females are more likely to develop borderline personality disorder which is characterized by unstable emotion (Keng et al., 2019).
Mounting research have focused on the gender difference in mental health among college students, but no consistent conclusion was drawn in this respect. Some studies concluded that female undergraduates exhibited mental problems more overtly (Adlaf et al., 2001). Especially, female students significantly suffered more from stress and anxiety (Bayram and Bilgel, 2008; Eisenberg et al., 2007; Mahmoud et al., 2012). As for the depression scale, some researchers found a higher prevalence rate of depression among female students (Liu et al., 2019c; Sun et al., 2017; Tung et al., 2018). By contrast, other researchers insisted that male students were more likely to experience depressive disorders than female students (Al-Qaisy, 2011; Wong et al., 2006), which corresponded with the statement that femininity appeared to be protective against depression symptoms for college educated people (Gibson et al., 2016). There were also studies which found no substantial gender effects concerning their mental health states (Grant et al., 2002). With regard to the attitudes toward seeking psychological help, some researchers pointed out that female students who suffered from mental disorders were proved to have more positive help-seeking attitudes, and this led to their favorable intentions to seek help from mental health professionals; on the other hand, males were more likely to underutilize the mental services due to their negative attitude towards psychological openness (Chandra and Minkovitz, 2006; Komiya et al., 2000; Mackenzie et al., 2006; Rith-Najarian et al., 2019). Moreover, depression, anxiety, and stress often lead to suicide, which is common among college students (Davis et al., 2019). Gender plays a role in suicide attempts as males tend to use lethal methods (Choo et al., 2017), and females tend to attempt suicide by drug overdose (Ho et al., 2016).
Given that mental disorders may pose grave threats to students’ academic performance on campus and predict their professional development in the future, it is of great significance to identify the influencing factors of college students’ psychological distress. Existing literature identified several sources of anxiety, stress and depression commonly seen among college students in various contexts. They can be categorized into four major aspects, i.e., students’ personality, lifestyle, family background, and academic performance. First, students’ personality determines their attitudes towards difficulties, as well as their willingness to express negative feelings. Extroverts were more likely to be optimistic and confident of their ability, whereas students with introverted personalities seemed to be at risk of physical and psychological health problems (Buckworth et al., 2002). Second, college students’ lifestyles play a vital role in their emotions. It was recognized that students’ levels of anxiety and depression had a significant correlation with their body image, particularly associated with overweight and obesity (Tao et al., 2002; Wahed and Hassan, 2017). Apart from that, substance use behaviors were usually associated with mental health problems, such as alcohol use disorders (Blanco et al., 2008), cigarette smoking (Halperin et al., 2009), and internet addiction (Yen et al., 2009), etc. Sleeping quantity and quality and psychological health issues also showed clear connections. Students who were poor sleepers experienced mental difficulties such as depression and anxiety (Orzech et al., 2011). Third, there was a significant relationship between psychological distress of college students and their family background, including their monthly household income (Wahed and Hassan, 2017), parental occupations and education (Tao et al., 2002), and their relationship with families (Zuckerman, 1989). Financial pressure, particularly, was considered as a significant negative predictor of their physical and psychological health (Andrews and Wilding, 2004; Jessop et al., 2005; Roberts et al., 2000). In addition, academic pressure was the top source of concern for college students regarding their depression, anxiety, and stress (Beiter et al., 2015; Misra and Castillo, 2004).
The review of literature indicated that although gender difference in mental health has been recognized for the general population, it was inconclusive among college students in this respect. Furthermore, most relevant studies employed cross-sectional designs. Considering college students of different years may be confronted with varying circumstances regarding their study and lives, there may be some distinctions in their psychological status over the four-year span. For example, aside from academic pressure, freshman students face stressful tasks of separation from their family (Pedrelli et al., 2015). Therefore, they may experience higher levels of anxiety than students of other years. Considering these research gaps, this study addressed three primary questions: (1) what are average levels of depression, anxiety, and stress among college students by gender during the four academic years? (2) what is the prevalence of mental problems in college students by gender, and does the prevalence vary by years? (3) how are students’ personality, lifestyle, family background and academic pressure associated with mental health problems for freshman students?
Section snippets
Participants and procedures
Our study used data collected from the Beijing College Students Panel Survey (BCSPS) in China. This survey adopted a probability proportional to size (PPS) sampling method and a three-stage sampling design was followed. The first stage of the sampling unit was universities; in this step, altogether 15 universities were chosen from 6 groups based on their rankings and administrative affiliation. The second sampling unit was majors, with 25 majors randomly selected from three elite universities
Gender differences in mean scores of depression, anxiety, and stress
Table 1 presents the mean scores, standard deviations, skewness and kurtosis of the three DASS scales (depression, anxiety, and stress) for both female and male students in college. Specifically, the mean scores of anxiety scale for female students varied from 3.34 to 3.86 during the four years, while male students scored between 3.35 and 3.60. By utilizing a two-way analysis of variance (gender and year) with one factor repetition (year) considering the same cohort was followed during college,
Discussion
Through a descriptive analysis of gender differences in mental health of students during college, female students suffered from significantly higher levels of anxiety than their male counterparts on average, especially in the freshman and sophomore years; while male students experienced more depressive problems. The results were congruent with some previous studies in different contexts (Al-Qaisy, 2011; Wong et al., 2006). We also found that the mean scores of depression, anxiety, and stress
Limitations
First, since our study involved a self-administered questionnaire survey, response bias may exist considering that students may have underreported their negative emotions or overreported their academic performance. Second, in the process of data collection, questions about the anxiety-related factors were only asked in the freshman year. Due to the limitations of data, we explored the correlation between anxiety and a series of variables merely in the first academic year, which can not
Conclusions
First, both female and male students suffered from mild anxiety in the first three years, and the mean anxiety score of female students significantly overtook that of the males in the first and second years. There were no significant gender differences in students’ average depression and stress levels.
Second, a significantly higher proportion of female students struggled with anxiety above the normal levels; whereas a significantly higher percentage of male students endured different degrees of
CRediT authorship contribution statement
Gao Wenjuan: Conceptualization, Formal analysis, Investigation, Visualization, Writing - original draft, Writing - review & editing. Ping Siqing: Data curation, Investigation, Resources, Writing - original draft, Writing - review & editing. Liu Xinqiao: Conceptualization, Data curation, Formal analysis, Resources, Visualization, Writing - original draft, Writing - review & editing.
Declaration of Competing Interest
None.
Acknowledgements
The authors would like to acknowledge and thank National Survey Research Center, Renmin University of China for the support in data collection. Wenjuan Gao would like to thank the support from Department of Education Policy and Social Analysis at Teachers College, Columbia University. Xinqiao Liu would like to thank the visiting scholar program of Department of Energy and Mineral Engineering, Pennsylvania State University.
Role of the Funding Source
This research has received no external funding.
References (58)
- et al.
The prevalence and correlates of depression, anxiety, and stress in a sample of college students
J. Affect. Disord.
(2015) - et al.
Substance use behaviors, mental health problems, and use of mental health services in a probability sample of college students
Addict. Behav.
(2009) - et al.
Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index
Am. J. Clin. Nutr.
(2000) - et al.
The role of sex, gender, and education on depressive symptoms among young adults in the United States
J. Affect. Disord.
(2016) - et al.
Gender differences in rates of depression among undergraduates: measurement matters
J. Adolesc.
(2002) - et al.
Predictors of depressive symptoms in college students: a systematic review and meta-analysis of cohort studies
J. Affect. Disord.
(2019) - et al.
Interventions to reduce stress in university students: a review and meta-analysis
J. Affect. Disord.
(2013) - et al.
Gender, negative life events and coping on different stages of depression severity: a cross-sectional study among Chinese university students
J. Affect. Disord.
(2017) - et al.
Prevalence of depression among nursing students: a systematic review and meta-analysis
Nurse Educ. Today
(2018) - et al.
Persistence of mental health problems and needs in a college student population
J. Affect. Disord.
(2009)
The prevalence of elevated psychological distress among Canadian undergraduates: findings from the 1998 Canadian Campus Survey
J. Am. Coll. Health
Gender differences in mental health
Singapore Med. J.
The relation of depression and anxiety to life-stress and achievement in students
Br. J. Psychol.
The relation of depression and anxiety in academic achievement among group of university students
Int. J. Psychol. Counsell.
The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students
Social Psychiatry Psychiatr. Epidemiol.
Mental health of college students and their non–college-attending peers: results from the national epidemiologic study on alcohol and related conditions
Arch. Gen. Psychiatry
Psychiatric comorbidity of smoking and nicotine dependence
Behav. Genet.
Incorporating personality assessment into counseling to help college students adopt and maintain exercise behaviors
J. Coll. Counsel.
Comparing weighting methods for nonresponse in the HKPSSD survey and the BCSPS
Chin. Sociol. Rev.
Stigma starts early: gender differences in teen willingness to use mental health services
J. Adolesc. Health
Gender differences in response to emotional stress: an assessment across subjective, behavioral, and physiological domains and relations to alcohol craving
Alcoholism
Prediction of lethality in suicide attempts: gender matters
Omega
Association between prescription opioid misuse and dimensions of suicidality among college students
Psychiatry Res.
Prevalence and correlates of depression, anxiety, and suicidality among university students
Am. J. Orthopsychiatry
Cigarette smoking and associated health risks among students at five universities
Nicotine Tob. Res.
Development of gender differences in depression: description and possible explanations
Ann. Med.
Profile differences between overdose and non-overdose suicide attempts in a multi-ethnic Asian society
BMC Psychiatry
Relationship of anxiety and depression with respiratory symptoms: comparison between depressed and non-depressed smokers in Singapore
Int. J. Environ. Res. Public Health
Gender role orientations and styles of pathology among adolescents
J. Health Social Behav.
Cited by (374)
A feasibility study on indoor therapeutic horticulture to alleviate sleep and anxiety problems: The impact of plants and activity choice on its therapeutic effect
2024, Complementary Therapies in MedicineThe association between sex-specific typologies of mobile phone addiction, alexithymia and negative emotions among college students: A latent profile analysis
2023, Children and Youth Services Review