Cited by 263Student Stress and CopingHealth and Well-being StudiesHealthcare professionals’ stress and burnout

Changes in Undergraduate Students’ Psychological Well-Being as They Experience University Life

Open access
Liu, Xinqiao, Ping, Siqing, Gao, Wenjuan·2019·International Journal of Environmental Research and Public Health

Abstract

The onset of most lifetime mental disorders occurs during adolescence, and the years in college, as the final stage of adolescence in a broad sense, deserve attention in this respect. The psychological well-being of undergraduate students can influence not only their academic and professional success, but also the development of society as a whole. Although previous studies suggested psychiatric disorders are common in the adult population, there was little consistent information available about undergraduate students’ mental health problems. This research aimed to describe the changes in depression, anxiety, and stress of Chinese full-time undergraduate students as they experienced university life using the Depression Anxiety Stress Scales-21 (DASS-21). The main conclusions of our study were as follows: (1) on average, students’ severity scores of depression during the four academic years varied between 7.22 and 7.79, while stress scores ranged from 9.53 to 11.68. However, the anxiety scores of college students in the first three years turned out to be 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7. These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years. (2) As for the proportions of students with different degrees of severity, approximately 38% to 43% of college students were above the normal level of anxiety, about 35% above the normal level of depression, and around 20% to 30% above the normal level of stress. (3) There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors; the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years. The findings suggested that colleges and universities need to pay special attention to psychologically unhealthy students, and with concerted efforts by the government, formulate mental health policies in the prevention, detection, and treatment of students’ psychiatric disorders, rather than just focusing on their average levels of mental health.

AI snapshot

Written from the paper’s full text.

TL;DR

This longitudinal panel study tracked a 2008 cohort of Chinese undergraduates across four years and found average depression and stress within normal ranges, but average anxiety above the normal threshold in the first three years. It also found significant differences in psychological well-being across academic years, with the highest depression, anxiety, and stress scores generally appearing in the first or second year and some improvement later.

Key findings

  • Average depression scores varied between 7.22 and 7.79 across the four academic years, and stress scores ranged from 9.53 to 11.68, both within normal cutoffs; anxiety scores were 7.40, 7.24, and 7.10 in the first three years, slightly above the normal threshold of 7, then fell to 6.63 in the senior year.
  • Approximately 38% to 43% of students were above the normal level of anxiety, about 35% above the normal level of depression, and around 20% to 30% above the normal level of stress.
  • The highest average scores of depression, anxiety, and stress all appeared in the first or second year; sophomores had relatively high depression and stress, while freshmen had relatively high anxiety.
  • Multiple group analysis showed significant differences in psychological well-being across years: no significant difference between freshman and sophomore years, but significant differences between sophomore and junior years and between junior and senior years (p < 0.05 for the structural covariances and measurement residuals models in the sophomore–junior comparison, and p < 0.05 for all three models in the junior–senior comparison).

Methods

  • Data came from the Beijing College Student Panel Survey (BCSPS) of the China Education Panel Survey; the 2008 cohort was randomly chosen from students admitted to 15 Beijing universities and tracked for four consecutive years from June 2009 to June 2012. The effective sample size was 1401 (650 females, 751 males), with follow-up rates of 95.27%, 94.66%, and 90.58% in the latter three rounds.
  • Psychological well-being was measured with the Depression Anxiety Stress Scales-21 (DASS-21), a self-report measure of depression, anxiety, and stress; scores were multiplied by two to compare with conventional severity cutoffs. Scale reliability coefficients were 0.813 for depression, 0.766 for anxiety, and 0.812 for stress.
  • Analyses used descriptive statistics and multiple group analysis, including unconstrained, factor-loading, structural-covariance, and measurement-residual invariance models to test differences across academic years.

Limitations

  • Stated limitations: Not stated in the paper.
  • Evident from the text: the sample is a single 2008 cohort of full-time undergraduates from 15 Beijing universities, so findings may not generalize to other regions, cohorts, or non-full-time students.
  • Evident from the text: DASS-21 is a self-report symptom-severity measure rather than a clinical diagnosis, and the fourth wave was conducted entirely online, which may affect response conditions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph16162864

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Around 35 percent of college students had above the normal levels of depression.

    “while around 35 percent had above the normal levels of depression.”
    • Also stated in: § Abstract · plain
      “about 35% above the normal level of depression”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • Findingown data

    More than 60 percent of students had a normal level of depression in the four years of college.

    “We noticed that more than 60 percent of students had a normal level of depression in the four years of college, while 12 to 17 percent of students suffered from moderate depression.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • Findingown data

    Students who suffered from moderate stress accounted for approximately 7 percent to 12 percent.

    “Students who suffered from moderate stress accounted for approximately 7 percent to 12 percent, while two to five percent struggled with severe stress on campus, and less than 1.1 percent had extremely severe stress.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • Findingown data

    There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors.

    “There were significant differences in the psychological health states of students of different years, especially among the sophomores, juniors, and seniors; the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • Findingown data

    There was no significant difference in students' psychological well-being between the freshman and sophomore years.

    “The results showed that there was no significant difference in students’ psychological well-being in the freshman and sophomore years, indicated by the measurement weights model, structural covariances model, and measurement residuals complete invariance model (p > 0.05).”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 11
  • May combine two claims.

    Findingown data

    The anxiety scores in the first three years were 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7.

    “Nevertheless, the anxiety scores in the first three years turned out to be 7.40, 7.24 and 7.10, respectively, slightly overtaking the normal threshold of 7.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • May combine two claims.

    Findingown data

    For the anxiety scale, freshman students scored 3.70 on average, and the scores decreased gradually from year one to year four.

    “For the anxiety scale, freshman students scored 3.70 on average, and the scores decreased gradually from year one to year four, indicating that this situation improved over time.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • May combine two claims.

    Findingown data

    A larger proportion of students reported having mild depression in their sophomore year while moderate depression was more likely to be seen in the senior year.

    “A larger proportion of students reported having mild depression in their sophomore year while moderate depression was more likely to be seen in the senior year.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • May combine two claims.

    Findingown data

    Factor loadings, unique variances, and factor variances were different across years.

    “Overall, these results indicated that the factor loadings, unique variances, and factor variances were different across years”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    Sophomore students endured relatively high levels of depression and stress, with mean scores reaching up to 5.84 and 3.89, respectively.

    “Sophomore students endured relatively high levels of depression and stress, with mean scores reaching up to 5.84 and 3.89, respectively.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • May combine two claims.

    Findingown data

    The highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years.

    “the highest score of depression, anxiety, and stress all appeared in the first or second year on average, but some improvements were achieved in the third and last years.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Students lost to follow-up do not differ systematically in mental health from those retained.
  • May combine two claims. The quote only partly states this claim.

    Findingown data

    There were statistically significant differences in psychological well-being between year 1 and 3, year 1 and 4, and year 2 and 4.

    “This indicated that strictly speaking, i.e., by holding factor loadings, variances and residuals as invariant, there were statistically significant differences between the latter three years.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Premisecitation

    Depression, anxiety, and stress are significant indicators of psychological well-being.

    “Indeed, depression, anxiety, and stress are deemed as significant indicators of psychological well-being [13].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Teh, 2015, Depression, anxiety and stress among undergraduate students: A cross sectional study, Open J. Epidemiol. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The DASS-21 is an effective measure of negative emotions in Chinese people.

    “The widely recognized Depression Anxiety Stress Scales-21 (DASS-21) is an effective measure of negative emotions in Chinese people [10,11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Quek, T., Ho, C., Choo, C., Nguyen, L., Tran, B., and Ho, R. (2018). Misophonia in Singaporean psychiatric patients: A cross-sectional study. Int. J. Environ. Res. Public Health, 15. source

      Not checked in the free run.

    • cites [11] Ho, C.S., Tan, E.L., Ho, R., and Chiu, M.Y. (2019). Relationship of anxiety and depression with respiratory symptoms: Comparison between depressed and non-depressed smokers in Singapore. Int. J. Environ. Res. Public Health, 16. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Students in their first year of college tended to suffer more from anxiety, while in the sophomore year they experienced relatively high levels of stress and depression.

    “Descriptive statistics showed that students in their first year of college tended to suffer more from anxiety, while in the sophomore year they experienced relatively high levels of stress and depression.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    Existing literature on college students' psychological distress mainly used cross-sectional data, and the few longitudinal studies often had a small sample size with participants mostly from a single university.

    “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.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Premisenone given

    There was little consistent information available about undergraduate students' mental health problems.

    “Although previous studies suggested psychiatric disorders are common in the adult population, there was little consistent information available about undergraduate students’ mental health problems.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationreasoning

    Sophomores may be confronted with intense pressure from study compared to previous semesters, which may lead to higher stress and even depression.

    “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.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Chinese universities usually set general courses in the first year and introduce more specialized courses from the second year.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The main groups at this age are college students in many countries.

    “The onset of most lifetime mental disorders occurs before young adulthood [46], and the main groups at this age are college students in many countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Kessler, 2007, Age of onset of mental disorders: A review of recent literature, Curr. Opin. Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Freshman students' 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.

    “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.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    On average, Chinese college students suffered from above-normal levels of anxiety in the first three years, but they stayed mentally healthy with mean scores of depression and stress in the normal range.

    “On average, Chinese college students suffered from above-normal levels of anxiety in the first three years, but they stayed mentally healthy with mean scores of depression and stress in the normal range.”
    • Also stated in: § Abstract · hedged
      “These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 2008 cohort of students from 15 Beijing universities is representative of Chinese full-time undergraduate students generally.
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The DASS-21 has been widely recognized for its reliability and different forms of validity in a range of studies from different countries with different samples.

    “The DASS-21 has been widely recognized for its reliability and different forms of validity in a range of studies from different countries with different samples [42,43].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [42] Osman, 2012, The depression anxiety stress Scales—21 (DASS-21): Further examination of dimensions, scale reliability, and correlates, J. Clin. Psychol. source

      Not checked in the free run.

    • cites [43] Oei, 2013, Using the depression anxiety stress scale 21 (DASS-21) across cultures, Int. J. Psychol. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    For this study, the scale reliability coefficients of depression, anxiety, and stress were 0.813, 0.766, and 0.812, respectively, indicating good validity of the DASS measurement.

    “For this study, the scale reliability coefficients of depression, anxiety, and stress were 0.813, 0.766, and 0.812, respectively, indicating good validity of the DASS measurement.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    The mental states of college students deteriorated from the freshman to sophomore year, with some improvements in the last two years.

    “In sum, the mental states of college students deteriorated from the freshman to sophomore year, with some improvements in the last two years.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The onset of most lifetime mental disorders occurs before young adulthood.

    “The onset of most lifetime mental disorders occurs before young adulthood [46], and the main groups at this age are college students in many countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Kessler, 2007, Age of onset of mental disorders: A review of recent literature, Curr. Opin. Psychiatry source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Participants of the BCSPS were randomly chosen from students admitted to 15 universities in 2006 and 2008.

    “Participants of the survey were randomly chosen from students admitted to 15 universities in the years of 2006 and 2008, and these two cohorts were tracked for four consecutive years from June 2009 to June 2012.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The follow-up rate of the latter three rounds was 95.27%, 94.66%, and 90.58%, respectively, with very few sample losses.

    “the follow-up rate of the latter three rounds was 95.27%, 94.66%, and 90.58%, respectively, with very few sample losses [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] Liu, X., Gao, X., and Ping, S. (2019). Post-1990s College Students Academic Sustainability: The Role of Negative Emotions, Achievement Goals, and Self-efficacy on Academic Performance. Sustainability, 11. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Chinese college students were mentally healthy on average, while the psychological health states of freshmen and sophomores warrants more attention.

    “With the above analysis, we can conclude that Chinese college students were mentally healthy on average, while the psychological health states of freshmen and sophomores warrants more attention.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The 2008 cohort of students from 15 Beijing universities is representative of Chinese full-time undergraduate students generally.
  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    The overall optimistic situation of the psychological state of college students may be due to their weak perception about changes in their external social environment.

    “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.”
    Quote in the paperNot a substantial claim
24 of 24
  • The paper relies on this without support.

    The 2008 cohort of students from 15 Beijing universities is representative of Chinese full-time undergraduate students generally.

    “On average, Chinese college students suffered from above-normal levels of anxiety in the first three years, but they stayed mentally healthy with mean scores of depression and stress in the normal range.”
  • The paper relies on this without support.

    Students lost to follow-up do not differ systematically in mental health from those retained.

    “the follow-up rate of the latter three rounds was 95.27%, 94.66%, and 90.58%, respectively, with very few sample losses [41].”
  • The paper relies on this without support.

    The 2009-2012 cohort's experiences are generalizable to current Chinese college students.

    “These results indicated that Chinese college students, in general, were mentally healthy with regard to depression and stress, but their average anxiety levels were beyond normal in the first three years.”
  • The paper relies on this without support.

    Chinese universities usually set general courses in the first year and introduce more specialized courses from the second year.

    “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”
  • The paper relies on this without support.

    Chinese college students usually pay much lower tuition for undergraduate study compared to their counterparts in the UK.

    “Chinese college students usually pay much lower tuition for undergraduate study compared to their counterparts in the UK”
  • The paper relies on this without support.

    Economic aids in China are relatively more accessible regarding both its simpler application process and also its better chance of success.

    “the economic aids in China are relatively more accessible regarding both its simpler application process and also its better chance of success”
  • The paper relies on this without support.

    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.

    “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.”
  • The paper relies on this without support.

    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.

    “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”
  • The paper relies on this without support.

    Previous literature on college students’ psychological well-being was generally based on cross-sectional data.

    “Previous literature on college students’ psychological well-being was generally based on cross-sectional data”
  • The authors state this as an assumption.

    The DASS-21 can be applied to examine students in different years.

    “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 [50,51,52,53,54].”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • University students represent a particularly vulnerable group prone to adopting unhealthy lifestyles that increase the risk of developing NCDs.

    “University students represent a particularly vulnerable group prone to adopting unhealthy lifestyles that increase the risk of developing NCDs [9, 10].”

    From Psychometric validation and measurement invariance of the Health-Promoting Lifestyle Profile II in Honduran university students (2025) · cites this paper as [9]

    The Introduction (page unavailable) describes college students as psychologically disadvantaged and says negative emotions may affect their lifestyle. It does not say students are particularly prone to adopting unhealthy lifestyles or that those lifestyles increase their risk of NCDs. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(6) = 43.823reported p < .05 · recomputed p < .001

    “χ2 (6) = 43.823, p < .05”

  • Consistentχ²(9) = 91.346reported p < .05 · recomputed p < .001

    “χ2 (9) = 91.346, p < .05”

  • Consistentχ²(3) = 47.522reported p < .05 · recomputed p < .001

    “χ2 (3) = 47.522, p < .05”

  • Consistentχ²(18) = 261.342reported p < .05 · recomputed p < .001

    “χ2 (18) = 261.342, p < .05”

  • Consistentχ²(9) = 169.996reported p < .05 · recomputed p < .001

    “χ2 (9) = 169.996, p < .05”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Sophomore depression and stress scores conflict with the reported ranges

    Minor

    The sophomore scores are presented as original scores, which the paper says are doubled for interpretation. Doubling the stated depression and stress scores gives 11.68 and 7.78, respectively-both outside the paper's reported four-year ranges for those measures. The two sophomore scores appear to have been reversed.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Wei, 2017, Research progress on family factors of depression for college students, China J. Health Psychol., 25, 1752

Cited by

Sorted by citations

Authors
Liu, X., Ping, S., & Gao, W.
Affiliations
  • Peking University (CN)
  • Department of Public Policy &amp; Management, Guangzhou Administration School, Guangzhou 510070, China
Corresponding author
Gao, Wenjuan
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2019-08-10
Volume
16
Issue
16
Pages
2864
ISSN
1660-4601 (ISSN-L)
OpenAlex
W2969073395
Cited by
261
References
53
Citations by year
2026: 31 · 2025: 44 · 2024: 55 · 2023: 41 · 2022: 48 · 2021: 28 · 2020: 13 · 2019: 1
FWCI
40.98
Type
journal article
Language
en
Open access
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information) (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Planning Project of Guangdong Philosophy and Social Science (GD18XGL60)
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
  • Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
psychological well-being, undergraduate students, college student life, depression, anxiety, stress, mental health, Chinese university students, academic year differences, DASS-21, mental health policy
MeSH terms
Anxiety, China, Depression, Female, Humans, Male, Mental Health, Stress, Psychological, Students, Universities

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

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