Using network analysis to identify central symptoms of college students' mental health

Background: Mental health problems are becoming increasingly common among college students, including depression, anxiety and sleep disturbances, which can affect their daily life and learning and even lead to suicide. The purpose of this study was to explore the gender differences in mental health symptoms among Chinese college students.Methods: The study population included 29,099 college students. All participants were assessed with the Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7), the Insomnia Severity Index (ISI), and the Suicidal Behaviors Questionnaire-Revised (SBQ-R). We assessed and compared network and centrality in females and males separately, as well as students with suicidal ideation.Results: Satisfaction with current sleep pattern (I4), worry about different things (A3) and irritable (A6) appeared to be the most central symptoms in the female network. In the male network, satisfaction with current sleep pattern (I4), tired or little energy (D4) and feeling down, hopeless (D2) were the most central symptoms. In both suicidal ideation networks, the top five central symptoms included four anxiety symptoms and one sleep symptom. Limitations: This study used cross-sectional data and could not examine the dynamic relationship between symptoms.Conclusion: There were gender differences in college students' mental health network. In addition to poor quality sleep, the central symptoms of the female network were anxiety symptoms, while those of the male were mainly depression symptoms. There were no gender difference in the suicidal ideation network and the central symptoms were anxiety symptoms and difficulty falling asleep.