A total of 2789 university students participated in this study. Their mean age is 20.9 (SD = 6.14) years. Most of them were females (64%), came from outside the capital Beirut (85%), were in their first (27%) and second (27%) year of university. The majority of the students are non-smokers (70%); 16% were water-pipe smokers, 11% cigarette smokers, and 3% were mixed smokers. The mean of students’ risky behaviors is 2.6± (SD = 0.67).
The majority of them sleep five to eight hours during the weekends (65%) and the weekdays (77%). The percentage of students who sleep less than five hours during weekdays is 17% and 8% during weekends. While 59% of the participants have a low physical activity level, the BMI mean is 22.72 Kg/m2 (SD = 3.61) with 68% of the university students having a normal weight status, 16% are overweight, 11% are underweight, and 5% are obese.
Concerning the food frequency intake, 60% have low calorie food consumption and 19% adopt high calorie food, 18% adopt processed food, while 3% consume hot beverages. Moreover, the results show that 20% of the participants are prone to anxiety and/or depression. According to the life skills, 89% of the participants have the overall life skills: 90% of the students have Relationship and Communication skills, 89% have the Self-Care skills, 86% of them have the Daily living skills, 84% have the skills for Goal Setting, 82% have skills in Work and Study Skills, 80% have the Career and Education Planning skills. The lowest percentage is 67% for Housing and money management skills.
Bivariate analysis was performed to examine the association between university students’ mental health and demographic and behavioral factors as well as life skills (Table 1).
Results showed a strong association between mental health and participants’ sex (p = 0.028); females are more prone to anxiety/depression (M = 35.02 ± 7.23 compared to 34.60 ± 6.25 for males). Also, the residence of the participants is a significant variable associated with their mental health (p = 0.026). Post-Hoc analysis showed a significant difference in the mental health status between Beirut and regions outside Beirut (p = 0.024). Students living outside the capital were more prone to anxiety and depression (36.42 ± 8.42).
Smoking is another variable that showed to be significantly associated with students’ mental health (p = 0.040). Post-Hoc analysis showed that differences were detected among sub variables (cigarettes, water pipes, and mixed smokers). Risk taking behaviors are also significantly and positively associated with students’ mental health with p < 0.001 and R = 0.10.
Moreover, a significant association was observed between mental health and physical activity (p = 0.047) while according to the Post-Hoc analysis, there is an absence in significant difference among the sub categories; low, moderate, and vigorous activities.
BMI is another significant factor associated with students’ mental health (p < 0.001). According to the Post-Hoc analysis, the significant differences are among underweight and normal students (p < 0.001) and between underweight and overweight students (p = 0.045). Underweight students have the highest mental health mean (M = 36.62 ± 5.95) while the normal weight students have the lowest mental health mean score (M = 34.74 ± 6.91). As for eating patterns, only low calorie diet (factor 1), and high calorie diet (factor 2) are significantly associated with students’ mental health where this latter is negatively associated with factor 1 (R = − 0.072) and positively associated with factor 2 (R = 0.132), the correlation with processed food and hot beverages is non-significant.
Analysis of the relation between life skills and mental health showed lower mental health mean scores among students who have the life skills compared to those who do not have them; For instance, students who have the Daily Living skills have a mental health mean score equal to 34.73 ± 7.09 compared to 36.88 ± 5.15. The difference is very remarkable among students who have the Self-Care skills where their mental health mean score is equal to M = 22.71 ± 4.62 compared to M = 37.39 ± 7.08 among those who do not have this skill.
Table 1
Characteristics of University students (n = 2789) according to the MH
Characteristic
|
MH (M ± SD)
|
P-Value
|
Sex
|
0.028
|
Males
|
34.60 ± 6.25
35.02 ± 7.23
|
Females
|
Region
|
0.026**
|
Beirut
|
34.37 ± 7.80
|
Outside Beirut
|
36.42 ± 8.42
|
Year at university
|
0.342
|
First
|
35.15 ± 6.84
|
Second
|
34.75 ± 6.55
|
Third
|
35.42 ± 7.75
|
Forth
|
34.99 ± 7.17
|
Master or PhD
|
34.39 ± 6.28
|
Smoking
|
Non-Smokers
|
35.00 ± 6.90
|
0.040
|
Cigarette Smokers
|
35.83 ± 7.29
|
Water pipe Smokers
|
34.80 ± 6.38
|
Both smokers
|
33.87 ± 7.49
|
Sleeping Hours (SH)
|
Weekdays < 5 hours
|
36.76 ± 3.07
|
0.510
|
Weekdays 5–8 hours
|
35.61 ± 5.91
|
> 8 hours
|
35.27 ± 6.47
|
Weekend < 5 hours
|
35.36 ± 7.56
|
0.169
|
Weekend 5–8 hours
|
34.75 ± 6.67
|
Weekend > 8 hours
|
35.54 ± 7.23
|
Age (mean)
|
R = 0.01
|
0.980
|
Risk Intake (RI) (mean)
|
R = 0.10
|
< 0.001
|
Physical Activity Questionnaire-Short Form (IPAQ-SF)
|
0.047
|
Low
|
34.89 ± 7.56
|
Moderate
|
35.52 ± 5.69
|
High
|
34.54 ± 5.82
|
Body Mass Index (BMI)
|
< 0.001***
|
Underweight
|
36.62 ± 5.95
|
Normal
|
34.74 ± 6.91
|
Overweight
|
35.26 ± 6.90
|
Obese
|
34.88 ± 7.91
|
Food Frequency Questionnaire (FFQ)
|
|
Factor1-Low calorie diet
|
R=-0.072
|
< 0.001
|
Factor 2- High calorie diet
|
R = 0.132
|
< 0.001
|
Factor 3- Processed food
|
R = 0.008
|
0.688
|
Factor 4- Hot beverages
|
R = 0.034
|
0.073
|
Life Skills*
|
Daily living
|
(+)34.73 ± 7.09
|
< 0.001
|
(-) 36.88 ± 5.15
|
Self-Care
|
(+)22.71 ± 4.62
|
< 0.001
|
(-)37.39 ± 7.08
|
Relationship & Communication
|
(+)34.76 ± 7.05
|
< 0.001
|
(-)37.29 ± 4.87
|
Housing & Money Management
|
(+)34.26 ± 6.51
|
0.024
|
(-)36.57 ± 7.37
|
Work & Study Life
|
(+)34.77 ± 7.10
|
< 0.001
|
(-)36.12 ±5.78
|
Career & Education Planning
|
(+)34.75 ± 6.25
|
0.009
|
(-)36.12 ± 6.25
|
Looking forward: Goal setting
|
(+)34.71 ± 6.95
|
0.029
|
(-)36.73 ± 6.34
|
life skills(total)
|
(+)34.77 ± 7.06
|
< 0.001
|
(-) 37.22 ± 4.67
|
P value is significant at p < 0.05 |
M = mean |
*All the results represent the subjects who have the life skills. |
**Post-Hoc: Beirut and South (p = 0.024 ). |
*** Post-Hoc: Underweight and Normal (p < 0.001), Underweight and Overweight (p = 0.045).
(+) students who have the life skills
(-) students who do not have the life skills
|
Multivariate Regressions
Linear regression models were conducted to adjust the effect of covariates on the students’ mental health. Based on testing several models in multivariate linear regression, the R2 was 0.76 for the final model which means that this model explains 76% of the variance for mental health (Table 2). This model was a significant predictor of the outcome variable with p value < 0.001.
In Model 1, region (p < 0.001), gender (p = 0.018), and university year (p = 0.028) were significant variables associated with students’ mental health. Female students are more prone to have anxiety and depression than male students (B = 0.045). Students who come from outside Beirut are more at a higher risk for depression and anxiety (B= -0.075). As for university year; the more advanced the student’s year is, the less likely they are to show signs of mental health disorders (B= -0.043)
When life skills were added in Model 2, the region (p = 0.03), university year (p = 0.019), and gender (p < 0.001) remained significant variables while only Housing & Money Management skills (p < 0.001) and Work & Study skills (p = 0.019) showed to be significantly associated with students’ mental health; students who have these skills have lower mental health score.with B= -0.13 and − 0.06 respectively.
BMI was added in Model 3 to show that it is not significantly associated with students’ mental health.
Finally, in Model 4, the behavioral factors were added including smoking, physical activity, food dietary intake, and risky behaviors. Variables from the previous models showed to be significant; region, gender, university year, Housing & Money Management skills as well as Work & Study life skills in addition to risky behaviors (RI) (p < 0.001), factor 1- low diet food (p < 0.001), and factor 2- high calorie diet (p < 0.001).
Age, sleeping hours, physical activity, smoking, body mass index, hot beverages and processed food, life skills components of Daily living, Self-Care, Relationship and Communications, Career and Education Planning showed to have non-significant association with university students’ mental health.
Table 2
Correlates of BMI among university students: multivariate analysis.
Model 1
|
Explanatory variables
|
Unstandardized coefficients
|
Standardized Coefficients
|
t
|
P value
|
β
|
Std. error
|
Β
|
|
Constant
|
39.371
|
1.557
|
|
25.284
|
0
|
|
Year
|
-0.779
|
0.355
|
-0.043
|
-2.192
|
0.028
|
|
Sex
|
0.650
|
0.274
|
0.045
|
2.371
|
0.018
|
|
Region
|
-1.591
|
0.405
|
-0.075
|
-3.926
|
< 0.001
|
Model 2
|
Explanatory variables
|
Unstandardized coefficients
|
Standardized Coefficients
|
t
|
P value
|
β
|
Std. error
|
Β
|
|
Constant
|
39.62
|
1.00
|
|
39.55
|
0
|
|
Sex
|
0.99
|
0.28
|
0.07
|
3.57
|
< 0.001
|
|
Region
|
-1.19
|
0.04
|
-0.05
|
-2.559
|
0.03
|
|
University year
|
-0.80
|
0.34
|
-0.04
|
-2.35
|
0.019
|
|
Housing & Money Management
|
-1.97
|
0.32
|
-0.13
|
-6.06
|
< 0.001
|
|
Work& Study Life
|
-1.19
|
0.50
|
-0.06
|
-2.34
|
0.019
|
Model 3
|
Explanatory variables
|
Unstandardized coefficients
|
Standardized Coefficients
|
t
|
P value
|
β
|
Std. error
|
Β
|
|
Constant
|
39.67
|
1.07
|
|
37.06
|
0
|
|
Sex
|
0.77
|
0.27
|
0.05
|
2.83
|
0.005
|
|
Region
|
-1.46
|
0.40
|
-0.06
|
-3.65
|
< 0.001
|
|
University year
|
-0.76
|
0.34
|
-0.04
|
-2.21
|
0.027
|
|
Money & House Management
|
-2.27
|
0.31
|
-0.15
|
-7.13
|
< 0.001
|
|
Work & Study Life
|
-0.14
|
0.39
|
-0.08
|
-0.37
|
0.017
|
Model 4
|
Explanatory variables
|
Unstandardized coefficients
|
Standardized Coefficients
|
t
|
P value
|
β
|
Std. error
|
Β
|
|
Constant
|
37.49
|
1.22
|
0
|
30.57
|
0
|
|
Sex
|
0.88
|
0.27
|
0.06
|
3.24
|
0.001
|
|
Region
|
-1.21
|
0.39
|
-0.05
|
-3.09
|
0.002
|
|
University Year
|
-0.61
|
0.33
|
-0.03
|
-1.82
|
0.049
|
|
Money & House Management
|
-0.64
|
0.19
|
-0.09
|
-3.30
|
0.001
|
|
Work & Study Life
|
-0.61
|
0.21
|
-0.07
|
-2.81
|
0.005
|
|
Low calorie diet
|
-0.13
|
0.02
|
-0.09
|
-4.82
|
< 0.001
|
|
High calorie diet
|
0.36
|
0.04
|
0.15
|
7.46
|
< 0.001
|
|
Risk Intake
|
1.09
|
0.19
|
0.10
|
5.75
|
< 0.001
|
|
Physical Activity
|
-1.02
|
0.21
|
-0.05
|
6.24
|
0.039
|
Model 1: y (MH) = β0 + (β1 * Demographics (age, gender, university year, sleeping hours)
Model 2: y (MH) = β0’+ (β1’ * Demographics) + (β2’ * Life skills)
Model 3: y (MH) = β0’’+ (β1’’ * Demographics) + (β2’’ * Life skills) + (β3’’ *BMI)
Model 4: y (MH) = β0’’’+ (β1’’’ * Demographics) + (β2’’’ * Life skills) + (β3’’’ *BMI) + (β4’’’ * Behavioral factors :physical activity, smoking, risk intake, eating patterns)
|
Stratification by gender
The data were stratified by gender (Table 3). The same models were conducted. The R2 was 0.83 for both males and females for the final model. These models were significant predictors of the outcome variable, mental health, with p value < 0.001.
For female students, the results of model 1 showed that university years and region are both significantly and negatively associated with female students’ mental health. Female students who belonged to areas outside Beirut are at higher risk for anxiety or/and depression (p = < 0.001, B= -0.082), also students who are at senior year in university are less likely to suffer with mental disorders (p = 0.014, B= -0.067).
In Model 2, life skills were added to show that three life skills components; Money & House Management, Work & Study Life, and Goal Settings showed to have a significant and inverse association with female students’ mental health scores (p < 0.001 and B = 1.570, -0.083, -0.075 respectively) in addition to the previous significant variables (region and university students).
Adding the BMI score as a variable to model 3 did not change the association between the previous significant variable and female students’ mental health.
The behavioral factors were added in model 4 to show that in addition to university year, region, and life skills (housing & money management, work & study life, and goal settings); risk taken action is significantly and positively associated with female students’ mental health (B = 0.116), p < 0.001, whereby a high mental health score is associated with higher risky behaviors. Also, low calorie food is inversely associated with female students’ mental health scores (B=-0.129) with p < 0.001, while high calorie food is positively associated with the mental health scores (B = 0.145) with P < 0.001. Female students with anxiety/depression are more likely to eat high calorie food.
Age, sleeping hours, physical activity, smoking, body mass index, hot beverage and processed food, life skills components: Daily living, Self-Care, Relationship and Communications, Career and Education Planning showed to have non-significant direct association with female emerging adults’ mental health.
As for the male students, model 1 showed that none of the demographic factors were significantly associated with male students’ mental health.
Adding life skills to model 2 showed that Daily living and Housing & Money Management are significant variables that are negatively associated with male students’ mental health scores (p = 0.046 and 0.042; B= -0.116, -0.071 respectively)In model 3, BMI was not a significant variable associated with male students’ mental health.
Model 4 showed that in addition to these two life skills components, high calorie intake and risk taking actions are both significantly and positively associated with students’ mental health. Therefore, students who have Daily living and Housing & Money Management skills are less likely to have mental health problems, while students who are adopting risky behaviors (p = 0.006, B = 0.085) and eating processed food (p < 0.001, B = 0.166) are more likely to have higher mental health scores, this means more mental health disturbance.
Age, sleeping hours, region, university years, physical activity, body mass index, low calorie food, hot beverages and processed food, life skills components: Self-Care, Relationship and Communications, Career and Education Planning, Work and Study Life, Goal Setting, showed to have non-significant association with male emerging adults’ mental health.
Table 3
Correlates of BMI among university students stratified by gender: multivariate analysis.
Gender
|
Model
|
Explanatory variables
|
Unstandardized coefficients
|
Standardized Coefficients
|
t
|
P value
|
Β
|
Std. error
|
β
|
Females
|
1
|
Constant
|
41.502
|
1.931
|
|
21.451
|
< 0.001
|
|
|
University Year
|
-1.124
|
0.451
|
-0.067
|
-2.448
|
0.014
|
|
|
Region
|
-1.900
|
0.522
|
-0.082
|
-3.623
|
< 0.001
|
|
|
Constant
|
41.523
|
1.392
|
|
29.837
|
< 0.001
|
|
2
|
University Year
|
-1.013
|
0.446
|
-0.054
|
-2.271
|
0.023
|
|
Region
|
-1.567
|
0.522
|
-0.072
|
-3.000
|
0.003
|
|
Housing & Money Management
|
-2.425
|
0.407
|
-1.570
|
-5.965
|
< 0.001
|
|
|
Work & Study Life
|
-1.714
|
0.640
|
-0.083
|
-2.679
|
0.007
|
|
|
Goal settings
|
-1.701
|
0.723
|
-0.075
|
-2.352
|
0.019
|
|
3
|
Constant
|
42.020
|
1.371
|
|
30.651
|
< 0.001
|
|
|
University year
|
-1.046
|
0.444
|
-0.056
|
-2.355
|
0.019
|
|
|
Region
|
-1.817
|
0.521
|
-0.083
|
-3.488
|
< 0.001
|
Housing & Money Management
|
-2.475
|
0.401
|
-0.160
|
-6.170
|
< 0.001
|
Work & Study Life
|
1.762
|
0.589
|
0.085
|
2.990
|
0.003
|
Goal settings
|
-1.604
|
0.609
|
-0.071
|
-2.634
|
0.009
|
4
|
Constant
|
36.979
|
1.487
|
|
24.868
|
< 0.001
|
University year
|
-0.751
|
0.437
|
-0.040
|
-1.718
|
0.04
|
Region
|
-1.451
|
0.508
|
-0.067
|
-2.857
|
0.004
|
Housing & Money Management
|
-2.444
|
0.397
|
-0.159
|
-6.152
|
< 0.001
|
Work & Study Life
|
1.776
|
0.581
|
0.086
|
3.056
|
0.002
|
Goal settings
|
-1.631
|
0.599
|
-0.072
|
-2.725
|
0.006
|
Risk Intake
|
1.222
|
0.249
|
0.116
|
4.914
|
< 0.001
|
Low Calorie Food
|
-0.191
|
0.037
|
-0.129
|
-5.199
|
< 0.001
|
Calorie Food
|
0.365
|
0.065
|
0.145
|
5.652
|
< 0.001
|
Males
|
1
|
Constant
|
38.296
|
2.632
|
|
14.553
|
< 0.001
|
2
|
Constant
|
37.858
|
0.461
|
|
82.034
|
< 0.001
|
|
Daily Living
|
-1.733
|
0.867
|
-0.1160
|
-1.998
|
0.046
|
|
|
Housing & Money Management
|
-0.927
|
0.546
|
-0.071
|
-1.696
|
0.042
|
|
3
|
Constant
|
38.244
|
0.710
|
|
53.898
|
< 0.001
|
|
|
Daily Living
|
-2.811
|
0.558
|
-0.187
|
-5.038
|
< 0.001
|
|
|
Housing & Money Management
|
-1.191
|
0.486
|
-0.091
|
-2.451
|
0.014
|
|
4
|
Constant
|
34.104
|
1.081
|
|
31.562
|
< 0.001
|
|
|
Daily Living
|
-2.741
|
0.564
|
-0.184
|
-4.860
|
< 0.001
|
|
|
Housing & Money Management
|
-1.304
|
0.485
|
-0.100
|
-2.689
|
0.007
|
|
|
Processed food
|
0.340
|
0.072
|
0.166
|
4.754
|
< 0.001
|
|
|
Risk intake
|
0.784
|
0.286
|
0.085
|
2.740
|
0.006
|
|
|
Physical Activity
|
0.121
|
0.274
|
0.054
|
3.21
|
0.047
|
Model 1: y (MH) = β0 + (β1 * Demographics (age, gender, university year, sleeping hours)
Model 2: y (MH) = β0’+ (β1’ * Demographics) + (β2’ * Life skills)
Model 3: y (MH) = β0’’+ (β1’’ * Demographics) + (β2’’ * Life skills) + (β3’’ *BMI)
Model 4: y (MH) = β0’’’+ (β1’’’ * Demographics) + (β2’’’ * Life skills) + (β3’’’ *BMI) + (β4’’’ * Behavioral factors :physical activity, smoking, risk intake, eating patterns)
|