The mediating effect of self-efficacy and physical activity with the moderating effect of social support on the relationship between negative body image and depression among Chinese College students: a cross-sectional study

doi:10.21203/rs.3.rs-4876240/v1

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Research Article

The mediating effect of self-efficacy and physical activity with the moderating effect of social support on the relationship between negative body image and depression among Chinese College students: a cross-sectional study

https://doi.org/10.21203/rs.3.rs-4876240/v1

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Background

Fitness to maintain an ideal body shape is becoming increasingly popular among college students. However, it also leads to many mental health issues. This study explores the pathways through which negative body image affects depression in college students. It also examines possible means of implementing depression interventions in college populations through the mediating roles of self-efficacy and physical activity, and the moderating role of social support.

Method

The present study employed a convenience sampling method to collect data from 600 university students using the Body Image Scale, Self-Efficacy Scale, Physical Activity Scale, General Social Support Scale and Depression Self-Rating Scale. Data analysis and structural equation modeling were conducted using SPSS, M-plus and R software.

Result

The result indicate that negative body image is positively correlated with depression. Self-efficacy and physical exercise play a chain mediating role between body image and depression. Additionally, social support moderates the effects of self-efficacy by predicting the pathway through which physical activity effects depression.

Conclusion

The study suggest that individuals with a negative body image are more prone to depression and that physical exercise can help alleviate their depressive symptoms. Self-efficacy is an important mediator, and social support moderates adherence to physical exercise. Therefore, attention should be paid to the mental health issues of college students with negative body images.

body image

depression

physical activity

self-efficacy

social support

A survey showed that approximately 41.6% of young people aged 15–25 are dissatisfied with their physical appearance[1]. This dissatisfaction may trigger a series of behavioral and emotional problems. Especially the impact of the pandemic on global mental health has been profound. According to research by Torales [2], the COVID-19 pandemic has triggered a wide range of mental health issues, including anxiety, depression, and Post-Traumatic Stress Disorder (PTSD). The incidence of eating disorders significantly increased during the pandemic. Studies have shown that lockdown and social distancing measures have exacerbated symptoms in individuals with eating disorder[3]. These measures not only restricted people's daily activities but also led to changes in eating habits and difficulties in weight management. Furthermore, the increase in social media use is also considered a significant factor contributing to the rise in eating disorders. Social media platforms are flooded with idealized body images, negatively impacting those already troubled by body image concerns. Concerns about body image also increased during the pandemic. Research found that people's worries about weight gain significantly rose during the lockdown[4]. These concerns not only affect people's mental health but may also lead to unhealthy eating behaviors and extreme weight loss measures. Body image is an individual’s comprehensive evaluation of his or her physical characteristics, including appearance, body size, physical strength, and health [5]. Body image significantly influences the mental health of college students[6]. Influenced by social and cultural factors, “slim” and “muscular” have become the mainstream body images that contemporary young women and men pursue. In college students, excessive concern about body shape and appearance and the pursuit of a ideal body shape can lead to higher rates of reduced body satisfaction[7]. Studies have indicated that negative body image is a predictor of the onset of depression in college student populations[8–10].

It has been demonstrated that there is a negative correlation between negative body image and physical activity[11]. Several studies have shown that physical activity significantly intervenes in depressed mood[12]. Exercise releases a variety of neurochemicals, such as endorphins, which help improve mood and alleviate depression. Additionally, it can enhance sleep, improve physical appearance, boost personal confidence, and increase life satisfaction. Regular physical activity also enhances an individual's physical aesthetics, which in turn mitigates negative emotions related to body image[13]. Therefore, this study hypothesizes that physical activity mediates the relationship between negative body image and depression.

Self-efficacy refers to an individual’s perception and prediction of his or her ability to accomplish a set goal, as well as the individual’s judgment and feelings about his or her behavioral tendency to achieve a certain goal[14]; its function is primarily reflected in influencing the college students’ cognitive, emotional, motivational, and behavioral choices[15]. It has been found that self-efficacy shows a significant negative correlation with depressed mood, with higher self-efficacy being associated with lower levels of depression[16–18]. This led to the hypothesis that the self-efficacy-physical activity association plays a protective role in the body image-depression relationship.

Social support refers to the material or moral support an individual can obtain through social connections[19]. It has been found that social support can enhance an individual's sense of self-efficacy and physical activity[20]. Research on the etiology of depression has shown that social support, as an essential resource for individuals coping with stressful life events, plays a key role in reducing the occurrence of depression in college students; strong social support can not only provide protection for individuals under stress but also maintain positive emotional experiences and reduce the occurrence of depression[21] .

Numerous studies have shown that regular regular participation in psysical activity not only expands the social network but also improves acceptance of and provision for social support, making physical activity a crucial way to increase social support levels[20]. When college students’ self-efficacy is weak, obtaining more social support can enhance their self-efficacy, which can affect the intensity, frequency, and efficiency of physical activity. Therefore, self-efficacy and physical activity improve the level of social support for college students[22]. Based on this analysis, we hypothesized that social support is a moderating variable in the process of self-efficacy affects physical exercise, and physical exercise affects depression.

Accordingly, we formulated the following research hypotheses for this study:

(1) Negative body image is positively correlated with depression.

(2) Self-efficacy and physical activity act as chain mediators between negative body image and depression.

(3) Social support plays a moderating role in the pathways of physical activity and depression, self-efficacy, and physical activity with the interaction of high support and self-efficacy having a stronger effect on depression.

Based on the three theoretical assumptions outlined above, this study constructs the theoretical hypothesis model illustrated in Fig. 1.

2.1. Participants

Simple random sampling was used to select 623 college students from three universities in Wenzhou City and Harbin City as a questionnaire survey, After deleting 23 invalid questionnaires due to incomplete or undifferentiated data, 600 valid questionnaires were recovered, yielding a valid response rate of 96.3%. All participants were aged18–24 years old. The study included 320 males and 280 females. In terms of majors, 186 participants were in science and technology (31%), 201 in arts (33.5%), 160 in medical fields (26.7%), and 53 in art majors (8.8%). Of the participants, 320 were an only child (53.3%), and 280 had siblings (46.7%).

2.2. Measures

2.2.1 Body image: The Body Image States Scale (BISS)[23], often used to measure body shape, was revised by Xiaoying Yang for the Chinese version. The BISS consists of 26 items divided into five subscales: health evaluation, appearance evaluation, physical fitness evaluation, appearance concern, and physical fitness concern. The scale is scored on a 5-point scale, where higher scores indicate a more positive body image. The Cronbach's α for this scale in this study was 0.869.

2.2.2. General Self-Efficacy Scale (GSES)

The scale is a 20-item instrument scored on a 4-point scale[24], with scores of 1, 2, 3, and 4 corresponding to “completely incorrect,” “somewhat correct,” “mostly correct,” and “completely correct,” respectively. Higher scores indicate higher self-efficacy. The Cronbach’s α for this study was 0.869.

2.2.3. Physical Activity Scale (PARS): Complied by the Japanese scholar Hashimoto[25]. The PARS-3 measures subjects’ physical activity using three indicators: intensity, time (duration of one exercise session), and frequency (number of exercise sessions in a month). The formula for calculating exercise volume is intensity × (time-1) × frequency. The scale rates exercise volume as follows: ≤19 points indicate a small amount of exercise; 20–42 points, a medium amount; and ≥ 43 points, a large amount. The Cronbach’s α for this scale was 0.82 in this study.

2.2.4. Social Support Scale: The Social Support Rating Scale (SSRS) measures the social support status of college students[26]. It consists of 10 items and includes three dimensions: objective support, subjective support, and utilization of support. Higher scores on each dimension indicate higher levels of social support received. Some items in the scale were revised for college students according to the method of Wu Qinglan. and the Cronbach’s α for the revised scale in this study was 0.88 .

2.2.5. Self-Rating Depression Scale (SDS): This scale consists of 20 items[27]. The total raw score is multiplied by 1.25, and the integer part is taken as the standardized total score. Classification criteria are as follows: an SDS score less than 50 indicates no depression, 50–59 indicates mild depression, 60–69 moderate depression, and 70 or more severe depression. The Cronbach’s α for this scale in this study was 0.94.

2.2.6. Procedure

Data were primarily collected via online We-Chat Star questionnaires and offline interviews, Subjects were informed of the questionnaires’ purpose and content during class sessions. Instructions for each item were explained in detail, and written consent was obtained from the subjects. The survey adhered to principles of anonymity, voluntariness, and confidentiality, allowing subjects to fill in the questionnaire by scanning a QR code on their cell phones. The survey content complied with the Helsinki Declaration and was approved by the Ethics Committee of [review for blind], with all subjects consenting to participate in the survey and the study.

The study data were analyzed using descriptive statistics using SPSS 22.0, and structural equation modeling was constructed using M-plus 7.0 and R software. A p-value p < 0.05 was considered statistically significance.

3.1. Common Method Variance Test (CMV)

Since the data were collected from the subjects' self-reports, there is a possibility of common method bias. Harman's single-factor test method was used to check the common method bias in the data. All items were loaded into an exploratory factor analysis to examine the unrotated factor structure. The results showed that the variance explained by the first factor without rotation was 16.6%, which is less than the critical value of 40%. Therefore, the data in this study do not exhibit common method variance.

3.2. Descriptive Statistical Analysis

Correlation analysis of each variable indicated that negative body image and depression were positively correlated, while self-efficacy and physical activity were negatively correlated with depression. Table 1 displays the results of each correlation index.

Table 1

Means, standard deviations, and correlations among key variables.
	M ± SD	Body image	Self-efficacy	Physical exercise	Depression	Social support
1. Body image	32.39 ± 8.77	1
2. Self-efficacy	26.15 ± 7.15	-0.26^**	1
3. Physical exercise	190.90 ± 30.13	-0.21^**	0.45^**	1
4. Depression	43.84 ± 8.11	0.31^**	-0.31^**	-0.48^**	1
5. Social support	35.65 ± 7.69	-0.38^**	0.33^**	0.32^**	-0.31^**	1
Note: * p<0༎05, p<0༎01, *p<0༎001. the same below.

3.3. Mediating Effects

The chain-mediated effects of self-efficacy and physical activity between body image and depression were first tested, followed by a moderated mediation model using Mplus 7.0 to examine social support as a moderator of the two pathways: self-efficacy and physical activity, physical activity and depression. We conducted a mediation analysis to elucidate the underlying mechanism of insomnia and to enhance the theoretical depth. The mediation model demonstrated ideal fit indices with χ²/df = 2.140, CFI = 0.995, TLI = 0.984, SRMR = 0.017, RMSEA = 0.030 .

Confidence intervals for the mediating and moderating effects were estimated by drawing 5000 samples using the bias-corrected percentile Bootstrap method. Statistically significant results were indicated when the confidence intervals did not contain zero. Table 2 and Table 3 display the results of the multiple mediation effects. Negative body image was a positive predictor of depression, as well as a positive predictor of self-efficacy and physical activity. Self-efficacy and physical activity were negatively predictive of depression. Furthermore, self-efficacy was a positive predictor of physical activity, suggesting that self-efficacy and physical activity act as chain mediators between body image and depression.

Table 2

Regression examining envy’s mediating effect
The regression equation		Overall fitting index			Significance of regression coefficient
Outcome variable	Predictors	R	R²	F	β	LLCI	ULI	t
Self-efficacy	Negative body image	0.25	0.06	40.33^***	-0.25	-0.33	-0.18	-6.35^***
Physical exercise	Self-efficacy	0.46	0.21	77.05^***	0.42	0.35	0.50	11.01^***
	Negative body image				-0.10	-0.18	-0.03	-2.74^**
Depression	Physical exercise	0.53	0.28	74.65^***	-0.40	-0.48	-0.32	-10.13^***
	Self-efficacy				-0.08	-0.21	-0.1	-3.4^**
	Negative body image				0.20	0.13	0.27	5.51^***

Table 3

The bootstrap 95% CI for the mediating effect test and deviation correction
Effect	Paths	Std. Estimate	Boot std	Bootstrap 95% CI	Estimate
Direct effect	Negative body image→Depression	-0.202	0.037	[-0.27, -0.13]	65.80%
Indirect effect 1	Negative body image→Self-efficacy→Depression	-0.020	0.012	[-0.15, -0.01]	6.51%
Indirect effect 2	Negative body image→Physical exercise→Depression	-0.042	0.022	[-0.09, -0.01]	13.68%
Indirect effect 3	Negative body image→Self-efficacy→Physical exercise→Depression	-0.043	0.012	[-0.07, -0.02]	14.01%
Total Indirect effect	/	-0.105	0.025	[-0.16,-0.06]	34.20%
Total effect	/	-0.307	0.040	[-0.38, -0.23]	100%

3.4. Moderating Effects

We also examined the paths of social support moderating the relationship between self-efficacy and physical activity and moderating the relationship between physical activity and depression. We found that social support was a significant predictor of physical activity and depression. The interaction of social support and self-efficacy was a significant positive predictor of physical activity, and the interaction term of social support and physical activity was a significant negative predictor of depression. This suggests that social support plays a moderating role between self-efficacy and physical activity and between physical activity and depression. Table 4 shows the results.

Table 4

The moderating role analysis of social support
Regression equation		Overall fitting index			Significance of regression coefficient
Outcome variable	Predictors	R	R²	F	β	LLCI	ULCI	t
Physical exercise	Self-efficacy	0.49	0.24	61.65^***	0.38	0.30	0.45	9.86^***
	Social support				0.18	0.10	0.26	4.66^***
	Self-efficacy×social support				0.29	0.02	0.14	2.60^**
depression	Self-efficacy	0.51	0.27	52.13^***	-0.11	-0.21	-0.07	-2.48**
	Physical exercise				-0.38	-0.47	-0.30	-9.35^***
	Social support				-0.16	-0.23	-0.08	-4.03^***
	Physical exercice×Social support				-0.1	-0.10	-0.01	-2.68^**

To understand the moderating role of social support better, we also differentiated subjects into high and low social support groups based on social support plus and minus one standard deviation and found that the mediating effect in the path of self-efficacy in predicting physical activity was significant in the high social support group, with a total indirect effect value of 0.267 (p < 0.001). The mediation effect was as significant in the low social support group, with a total indirect effect value of 0.12 (p < 0.05), and the difference in the amount of mediation effect between the two groups was significant (p < 0.001). Similarly, in the pathway of physical activity predicting depression, the mediation effect was significant in the high social support group, with a total indirect effect value of 0.233 (p < 0.001), and it was just as significant in the low social support group, with a total indirect effect value of 0.15 (p < 0.05). The difference in the magnitude of the mediation effect between the two groups was significant (p < 0.001). Figure 2 shows the corresponding simple slope plot. For the low social support group, self-efficacy was a significant positive predictor of physical activity (b_simple=0.18, t = 5.34, p < 0.05) and physical activity was a significant negative predictor of depression (b_simple=0.20, t = 6.19, p < 0.05), and for the high social support group, self-efficacy was a stronger positive predictor of physical activity (b_simple=0.29, t = 7.04, p < 0.05) and physical activity was a stronger predictor of depression (b_simple=0.34, t = 9.76, p < 0.05).

In this study, we explored the relationship between body image and depression among college students, examining the chain-mediating roles of self-efficacy and physical activity, and the moderating role of social support. We identified key factors that might intensify the link between body image and depression. Our findings confirm the hypotheses that (1) there is a negative correlation between negative body image and depression. (2) self-efficacy and physical activity mediate this relationship, and (3) social support moderates the pathways between self-efficacy and physical activity as well as between physical activity and depression.

4.1. Body Image and Depression

Our study revealed a significant negative correlation and predictive relationship between negative body image and depression, aligning with prior research indicating that poorer body image correlates with higher levels of depression and increased susceptibility to negative emotions[28–29]. According to social comparison theory, individuals evaluate their own abilities and appearances in relation to others, often resulting in diminished self-assessment and negative emotions. The hopelessness theory suggests that a direct cause of depression is a sense of hopelessness, exacerbated by negative judgments and adverse life events[30]. Notably, a study reported significant disparities in body image perceptions among males and females with normal BMI[31], which may contribute to the negative emotions experienced during physical changes in puberty. These findings emphasize that dissatisfaction with body image can trigger negative emotions leading to depression[32–33].

4.2. The Mediating Role of Self-Efficacy

We found that a positive body image is positively associated with self-efficacy, which in turn negatively affects depression. Self-efficacy and physical activity mediated the relationship between body image and depression. This is consistent with previous research that the higher self-efficacy for college student, the lower depression they will be. Regarding the reasons behind this, first, body image is the perception and evaluation of one’s body image, self-efficacy is largely derived from self-perception[34], and poorer body image leads individuals to have negative perceptions and evaluations of themselves, reducing their self-efficacy and making them less confident and fearful when they encounter difficulties, which can lead to depression[35]. Second, when college students’ body image are high, they will receives a higher level of respect and appreciation from socialization, resulting in high self-esteem, and students with high self-esteem tend to be physically and mentally happy, experience success, and present themselves in a way that can effectively prevent depression from occurring. This suggests that self-efficacy plays a mediating role between body image and depression.

4.3. The Mediating Role of Physical Activity

The present study found that a positive body image had a significant positive correlation with physical activity, and that physical activity had a significant negative correlation with depression. College students who maintain regular exercise tend to maintain a positive mood[36]. Their misperceptions, excessive worries and unhealthy expectations about their external physical appearance during self-evaluation can cause anxiety and depression, which can enhance the desire to achieve an ideal appearance[37–38]. This leads to the adoption of various methods of change, such as physical exercise[39]. With prolonged and regular physical exercise, individuals becomes fitter, which can psychologically enhance their positive emotions and reduce the occurrence of depression[40]. College students with a more positive body image and enhanced self-efficacy are more likely to persist in physical exercise for the sake of self-presentation and the need to maintain a good body shape[41]. Therefore, low self-efficacy induced by a negative body image may encourage individuals to intensify their physical activity and enhance their satisfaction with their body aesthetics[42].

4.4. The Moderating Role of Social Support

This study showed that self-efficacy has a positive correlation with social support, and social support is positively correlated with physical activity and negatively correlated with depression. This is consistent with previous studies that indicate higher self-efficacy and reduced depression occurrences among college students who receive substantial social support [43–44]. Social support acts as an external positive protective factor, providing problem-solving intervention strategies and approaches[45]. College students with poor body image often have negative and pessimistic attitudes toward changes in their shape, and they exhibit fearful and anxious attitudes toward physical activities that could alter their body shape, resulting in significantly lower self-efficacy [46]. According to the quality-stress model, social support can mitigate the effects of stress by enhancing effective coping skills, reducing the use of negative coping strategies such as avoidance and withdrawal; viewing stress as a challenge that can be overcome; choosing more challenging tasks, and setting higher goals for themselves[47], which can enhance physical activity.

The social support buffer model suggests that social support primarily operates through a person’s internal cognitive system[48]; If college students receive adequate social support, they are likely to underestimate the harmfulness of stressful situations and reduce their appraisal of the stressful events by increasing their perceived ability to cope. As social support for physical activity increases, so does the time, frequency, and intensity of the activity, More engagement in physical activity leads to increased vigor, easier release of suppressed emotions, and greater physical satisfaction, effectively reducing depression[49–50].

4.5. Intervention Recommendations for Depression Triggered by Body Image Deviations in College Students

For students with a negative body image, schools should provide a variety of sports activities, allowing students of different athletic levels to participate, which effectively encourages them to regulate and reduce negative emotions. Additionally, students with a negative body image should be offered suitable physical exercise options, such as running, yoga, rope skipping, and ball games. They also require increased social support and assistance. At the same time, more encouragement and psychological support can be provided to boost their self-efficacy. Parents, teachers or friends can assist students with with a negative body image in creating a weekly exercise program, supervising and rewarding adherence to this program, or even hiring a fitness instructor to ensure they maintain regular, consistent-intensity physical exercise to mitigate depression.

4.6. Limitations and Prospects

This study has several shortcomings. First, regarding data collection, we relied on self-assessments in the questionnaire. Although the data passed the common method bias test, the absence of other forms of assessment could affect the survey's objectivity. Future studies should incorporate data from multiple sources, such as parents, peers, and teachers, to enhance objectivity. Second, we utilized a cross-sectional approach, which allows us to describe the general psychosomatic development of college students during a specific period, but limits our ability to infer causality. Researchers should further explore causal relationships using theoretical modeling and time-series longitudinal data analysis methods.

This study established a moderated mediation model to examine the influencing factors and mechanisms of depression in college students. The research analysis result showed that:

(1) College students’ dissatisfaction with their physical appearance may induce depression. (2) Physical activity can change the association between body image and depression, with self-efficacy being an important mediator. (3) Social support can modulate adherence to exercise, thus providing an intervention for depression.

These findings suggest that attempting to adjust individual self-efficacy and physical activity to alleviate depression may provide new perspectives and recommendations for clinical intervention in mental health, which may yield the greatest benefits by making physical activity regulation strategies more accessible to patients.

Acknowledgment

We would like to share our sincere gratitude for the reviewers’ and editors’ constructive suggestions and valuable comments. We also would like to thank professor Ke Jiang who also helped to give some suggestions and participate in the manuscript revise.

Ethic approval and consent to participate

In accordance with the Helsinki Declaration, the study was conducted and revised under the approval of the ethics committees of Wenzhou Medical University. Informed Consent was obtained from all subjects. The participants were required to follow instructions, and the data recorded were alphanumerically coded to ensure anonymity following the law on the protection of personal data.

Consent for publiction

Not applicable

Availability of Data and Materials

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.

Funding

This work was supported by the BK21 FOUR(fostering Outstanding University for Research, NO.51202200913674) funded by the Ministry of Education(MOE, Korea) and the National Research Foundation of Korea(NRF). Wenzhou philosophy and social science planning annual project [23WSK025YB].

Competing Interest

Authors have no conflicts of interest to declare.

Authorship contributions:

Ye Yuan and Yuqi Su : Conceptualization, Methodology, Software, Data collection, Data analysis, Writing-Original Draft.

Ke Yang: Data collection, Conceptualization

Leijin : Conceptualization and English Translation.

Huapei Mao and Junyi Zheng supervised the whole research process and revised the draft.

Daili wu and Qiang Zhou: Designed the research, revised the manuscript and fund the research.

All authors have approved the final version of the submission.

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No competing interests reported.

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The mediating effect of self-efficacy and physical activity with the moderating effect of social support on the relationship between negative body image and depression among Chinese College students: a cross-sectional study

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Abstract

Background

Method

Result

Conclusion

Figures

1. Background

2. Methods

2.1. Participants

2.2. Measures

2.2.2. General Self-Efficacy Scale (GSES)

2.2.6. Procedure

3. Results

3.1. Common Method Variance Test (CMV)

3.2. Descriptive Statistical Analysis

3.3. Mediating Effects

3.4. Moderating Effects

4. Discussion

4.1. Body Image and Depression

4.2. The Mediating Role of Self-Efficacy

4.3. The Mediating Role of Physical Activity

4.4. The Moderating Role of Social Support

4.5. Intervention Recommendations for Depression Triggered by Body Image Deviations in College Students

4.6. Limitations and Prospects

5. Conclusion

Declarations

References

Additional Declarations

Status:

Version 1