Mental health concerns are on the rise among undergraduate students, with a significant proportion experiencing severe levels of depression, anxiety, and stress (Emmerton et al., 2024). In the Philippines, mental health concerns like depression and anxiety are steadily rising (Alejandria et al., 2023). As a matter of fact, a recent survey conducted by the Philippine Commission on Higher Education has noted that mental health concerns ranked fourth as the most common reason for undergraduate students to stop schooling (Bordey, 2024). Likewise, a nationwide survey on Filipino youth revealed that today's Filipino youth have poorer mental well-being, with one in every five (15 to 24 years old) considering ending their own lives (UPPI, 2022). Volatile household dynamics, intergenerational misunderstandings of mental illness, stressful academic engagement, and religious associations have been found to be contributory factors to the individual framing of mental health concerns. The framing ranged from stigma to isolation (Alejandria et al., 2023).
In 2022, Li et al. conducted a meta-analysis of 64 studies revealing that the highest prevalence of depression symptoms was found in the African region, in lower middle-income countries, and among undergraduate medical students. Specifically, there was a 35.9% prevalence of depression symptoms, which was even higher after the COVID-19 pandemic. Focusing on specific countries, Heumann et al. (2023) found a 12 to 29% prevalence of depressive symptoms among German undergraduate students. In Malaysia, the prevalence of moderate to extremely severe depression was recorded at 21% (Amir Hamzah et al., 2019), which was even before the onset of the COVID-19 pandemic. Among Thai adolescents, Choychoda (2023) found that the prevalence of mild to severe depression was 72.2%.
Additionally, the study of Bazargan et al. (2023) revealed a high prevalence of depression among Iranian adolescents (33%). In Sri Lanka, Alwis et al. (2024) found that one-fifth of the population (19.4%) was diagnosed with depression, with the highest prevalence reported among young people (39%). based on the quantitative synthesis of data from 33 studies with subjects representing non-clinical samples. In Nigeria, based on data extracted from 10 studies, the pooled prevalence of depression was 28.13% (Anbesaw et al., 2023), while in Saudi Arabia, using 46 relevant cross-sectional studies, the pooled depression prevalence was 37.35% (Nour et al., 2023).
Several factors were found to be associated with depression. On a personal level, factors include being female (Anbesaw et al., 2023; Nour et al., 2023), being a first-year student, being a transferee student (Cheung et al., 2020), prolonged sedentary time (Zheng et al., 2024), alcohol use (Anbesaw et al., 2023), having medical problems, sleep disorders, the presence of psychiatric/psychological conditions, lack of social support, educational/personal problems, electronic device usage (Nour et al., 2023; Zheng et al., 2024), and exposure to stress (Nour et al., 2023; Yang et al., 2023; Zheng et al., 2024). On a familial level, these factors include poverty/financial difficulties (Choychoda, 2023; Heumann et al., 2023; Nour et al., 2023), family history of mental illness (Anbesaw et al., 2023), living with non-family members (Amir Hamzah et al., 2019), absence of parental supervision (Singh et al., 2023), familial concerns (Yang et al., 2023), and poor housing conditions (Nour et al., 2023; Zheng et al., 2024). In addition, factors like originating from an Asian country (Souza et al., 2023) and the experience of lockdowns (Barendse et al., 2023) have been identified, which were neither personal nor familial.
To understand the prevalence of anxiety, Tan et al. (2023) reviewed 25 articles that covered Africa, the Arab States, Asia-Pacific, Europe, the Middle East, North America, and South America. The overall prevalence of anxiety among undergraduate students had a median of 32%, ranging from 7.4% to 55%. Likewise, Ahmed et al. (2023) explored the prevalence of non-specific anxiety among undergraduate student populations. A weighted mean prevalence of 39.65% for nonspecific anxiety was recorded. Additionally, through meta-analysis, Deng et al. (2023) found a 31% pooled prevalence of anxiety symptoms. In addition, results from the review of 27 studies revealed that the pooled prevalence of anxiety was 39.4% (Batra et al., 2021). Similarly, a 42.4% median point prevalence for anxiety (Dessauvagie et al., 2022) was recorded based on the review of 34 articles on the prevalence of mental health concerns among undergraduate students in Southeast Asia (Cambodia, Laos, Malaysia, Myanmar, Thailand, and Vietnam). Based on the study conducted by Li et al. (2022), the highest prevalence of anxiety symptoms was observed in North America, lower middle-income countries, and among undergraduate medical students. Anxiety prevalence was at 40.7% and was higher after the onset of the COVID-19 pandemic.
With reference to country-specific prevalence, Heumann et al. (2023) found 32% prevalence of anxiety among German undergraduate students, while 50% prevalence was observed among Malaysian undergraduate students (Amir Hamzah et al., 2019). Comparably, using four-year cohort data, Cheung et al. (2020) found that there was a 30.9% prevalence among Chinese student transferees from community colleges. Traumatic childhood experiences, both in school and in the family (Yu et al., 2023); experience of financial difficulties (Heumann et al., 2023); experience of lockdowns (Barendse et al., 2023); living with non-family members (Amir Hamzah et al., 2019); peer relationships; and student satisfaction with culture, parenting style, and family relationships (Liu et al., 2023) were identified as associated factors.
Academic-related and non-academic-related were the two main classifications of stress among undergraduate students. Examinations, inadequate time to study, low grades, an extensive amount of learning content, the need to perform well in examinations (Paudel et al., 2023), university adjustment factors, and ways of coping methods (Hwang et al., 2023) were identified as academic-related concerns. Experiences of lockdowns (Barendse et al., 2023), experiences at home (Olson et al., 2023), financial concerns (Rahlin et al., 2024), concerns relating to food, housing, transportation, health, and legal concerns for international students (Xiong, 2023), gender, parental status, sleep quality, residence in conflict zones, and social media usage (Dopelt & Houminer-Klepar, 2024) were identified as non-academic-related concerns.
With respect to country-specific prevalence, Hathaway et al. (2023) found that 82% of undergraduate students in a study conducted at a US university had moderate or high perceived stress. Among Malaysian undergraduate students, a prevalence of 12% was revealed (Amir Hamzah et al., 2019). A stress prevalence of 13.6% was observed among transferee students from community colleges in China (Cheung et al., 2020). In Israel, undergraduate students had moderate to high stress levels (Dopelt & Houminer-Klepar, 2024).
A number of extant literature (e.g., Armstrong et al., 2024; Dopelt & Houminer-Klepar, 2024; Nour et al., 2023; Zheng et al., 2024) identified the influence of physical health on mental health concerns. As shown in the study of Doan et al. (2023), physical health promotion, health problems, risks, and shocks were important to physical health changes and eventually to mental health. Thus, neglecting physical health can negatively impact mental health (Woffindin, 2023). To be specific, Mahindru et al. (2023), through a review of extant literature, found that physical activity not only helped with sleep but also with the improvement of symptoms associated with psychiatric disorders. Specifically, exercise was associated with better mood and quality of life. Similarly, Malagodi et al. (2024) claimed that physical activity was associated with better mental health in higher education settings. Also, through a meta-analysis, Huang et al. (2023) found that physical exercise was effective and has a positive role in reducing depressive and anxious moods. The authors believed that physical exercise can be used as a non-medical method to improve the mental health of undergraduate students and promote their full development. In relation, the study conducted by Zheng et al. (2024) highlighted the importance of healthy lifestyles like regular exercise, limited electronic screen time, and a balanced diet with activities like basketball, tennis, dance, and running, which were effective in lessening mental health concerns. Focusing on total body composition, Torres et al. (2023) found strong and significant correlations between anxiety and depression symptomatology and body fat percentage and between anxiety and depression symptomatology and skeletal muscle mass. Symptomatology increased with added body fat and decreased with added skeletal muscle mass.
With reference to sleep, Du et al. (2021) found that the COVID-19 pandemic influenced the health behaviors of students in European countries (Ireland and the Netherlands) and the USA more negatively than Asian countries (China, Malaysia, South Korea, and Taiwan). Undergraduate students, according to the authors, who experienced a decline in sleep quality had higher dietary risk scores. In the same light, Fudolig et al. (2024) also highlighted the importance of sleep. To be specific, a significant predictor of self-reported impairment due to anxiety or depression was consistently reaching the lowest heart rate later during sleep. The association was more pronounced among females. Comparatively, Hutchesson et al. (2023) found consistent relationships between poor sleep and physical inactivity and poor psychological well-being based on a review of 33 studies.
Students, compared to the general population, had an increased rate of depression, anxiety, and suicidal ideation, with females being more prone to mental health disorders (Cody et al., 2024). Relatively, Armstrong et al. (2024) believe that females have the highest prevalence of mental illness, particularly those in college. This reality impacts their social connection, performance in academics, and even their physical health. Similarly, Siddik et al. (2024) found that female undergraduate students were more depressed and anxious compared to male undergraduate students. Also, Alalalmeh et al. (2024) found higher levels of anxiety and stress among female undergraduate students. In relation, Pei et al. (2024) found that female undergraduate students reported higher rates of treatment receipt compared to male undergraduate students. Factors affecting the mental health of female undergraduate students based on previous studies were marital status, financial conditions, education levels, family structure (Nahar et al., 2022), health-related behaviors like engagement in sports (basketball, tennis, dance, and running), exercise frequency, eating healthy food, a non-sedentary lifestyle, little electronic usage time (Zeng, 2024), and alcohol use (Armstrong et al., 2024).
To date, there are no previous studies specifically focusing on physical health concerns among Filipino undergraduate students, but there are some previous studies on physical activity, which may in turn affect physical health. For example, even before the onset of the COVID-19 pandemic, results from the study conducted by Acampado and Valenzuela (2018) already found that only 32.8% of students engaged in regular physical activity, with lack of time identified as the primary reason. In addition, one in every three students in every year level had below-average to poor dietary habits. Also, Manasan et al. (2023) found that most participants in their study did not have much time and were too lazy to exercise because of the claim that it may interfere with their academic-related tasks. Similarly, Santiago and Ibarra (2023) found that the body composition and the strength of the students' need improvement, which can be attributed to a lack of exercise. In relation, Cagas et al. (2022) claimed that despite the existence of government policies on physical activity, the majority of children and adolescents in the Philippines were still not able to meet the recommended physical activity needed to be healthy.
Some previous studies have equally noted mental health concerns. For example, the study of Puyat et al. (2021) found that one in 10 Filipino young adults experience moderate to severe depression, with the prevalence higher in females. Similarly, in the study of Sampaga-Fernandez and Cardinal (2024), more than half of adolescent participants were identified to have anxiety disorders, with social anxiety being the most predominant, followed by panic disorder and generalized anxiety disorder. Also, one out of four participants in the study of Serrano et al. (2023) was found to be at risk for significant stress. Post-lockdown, higher psychological distress was similarly reported among females, gender and sexual minorities, and those with lower ratings for family, respect for diversity in school, and low life satisfaction (Cleofas, 2023).
However, despite the previous studies conducted on physical health and mental health, whether in the Philippines or abroad, there are still gaps in literature that need to be addressed. First, while literature suggests that mental health concerns were more prevalent among females, there seems to be a scarcity of research conducted specifically among female undergraduate students. Second, while literature suggests that physical health affects mental health, there was a scarcity of studies conducted on specific physical health concerns, particularly sleep disturbances, headaches, gastrointestinal problems, and respiratory infections. Fortunately, some theories can explain the physical and mental health connection and can be used as a guide to fill in the gap in literature. For example, the Biopsychosocial Model of Engel (1977) believes that boundaries between health and disease and well and sick are never clear because they are diffused by cultural, social, and psychological considerations. Therefore, biological, psychological, and social factors all play important roles for the individual.
Specifically, there are theories suggesting a possible contribution of physical health concerns to the experience of depression, anxiety, and stress, like the Hopelessness Theory of Depression (Abramson et al., 1989). The theory believes that attributions, or personal explanations for the causes of an event, are important in determining whether depression is experienced during a negative event. Physical health concerns are examples of negative events. Additionally, the Three Stage Schema-based Information Processing Model (Beck & Clark, 1997) suggests that anxiety starts with an initial registration of a threat stimulus, followed by an activation of a primal threat mode and the secondary activation of more elaborative and reflective modes of thinking. Physical health concerns are considered stimuli, which may increase anxiety. The Stimulus Theory of Stress (Holmes & Rahe, 1967; Masuda & Holmes, 1967) suggests that life changes or events are considered stressors to which a person needs to respond. Physical health concerns are life events that may lead to changes. In line with these theories, the present study aimed to describe the experience of depression, anxiety, and stress together with physical health concerns among Filipino female undergraduate students. Also, specific health concerns like sleep disturbances, headaches, gastrointestinal problems, and respiratory infections were investigated to see whether they can serve as influencing determinants of depression, anxiety, and stress.
In the end, previous studies suggest the prevalence of mental health concerns, and giving due attention to these concerns is important. This is so because these concerns, particularly those in late adolescence, serve as risk factors for reporting poor mental health six years later. This provides evidence for the chronicity of mental health concerns from adolescence to adulthood (Sivertsen et al., 2024) and highlights the importance of early identification and timely interventions (Siddik et al., 2024; Sivertsen et al., 2024). Also, there is a need to identify resources against mental health concerns, and physical well-being may be one of them. The importance of a holistic approach that addresses both psychological and physical aspects of well-being has been highlighted in the study conducted by Han et al. (2024) and further justifies the conduct of the present study. Mental health services, together with healthy living, should be encouraged (Siddik et al., 2024), especially in a country like the Philippines, where mental health concerns are rising.
The present study investigated the influencing role of physical health concerns, particularly sleep disturbances, headaches, gastrointestinal problems, and respiratory infections, in the experience of depression, anxiety, and stress among Filipino female undergraduate students enrolled in a state university. The participants were freshman and sophomore undergraduate students enrolled during the first-ever semester of residential classes after the COVID-19 pandemic. Results of the investigation can be used in the crafting of a contextualized mental health program.
The present study used the complex correlational research design. Descriptive statistics were used to analyze the responses of the participants. Multiple regression modeling, in particular, was used to identify possible relationships among different variables (Casinillo, 2022). The main goal in the present study was to investigate the experience of depression, anxiety, and stress with physical health concerns as influencing determinants.
The present study included a total of 976 female undergraduate students with a mean age of 18.87 and a standard deviation of 1.44. These female undergraduate students came from 23 programs of a state university in the Philippines and were officially enrolled during the school year 2023–2024.
The present study used two research instruments. These were the Depression, Anxiety, and Stress Scale-21 items (DASS-21) and the Physical Health Questionnaire (PHQ). Below are the descriptions of the research instruments used:
The DASS-21, developed by Lovibond and Lovibond (1995), has three self-report scales intended to measure the emotional states of depression, anxiety, and stress. The depression scale measures dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The stress scale measures difficulty relaxing, nervous arousal, and being easily upset, agitated, irritable, overreactive, and impatient. It is sensitive to levels of chronic, non-specific arousal. There are seven items on every scale. DASS-21 is based on a dimensional rather than a categorical conception of psychological disorder. A Cronbach's α ranging from 0.77 to 0.83 was computed for the subscales of DASS-21 by using the responses from the present study.
The PHQ developed by Schat et al. (2005) is a self-report scale of somatic symptoms. It is the shortened and modified version of the health scale by Spence et al. (1987). There are 14 items on the scale. Also, there are four subscales: sleep disturbances, headaches, gastrointestinal problems, and respiratory infections. A Cronbach's α ranging from 0.58 to 0.82 was computed by using the responses in the subscales from the present study.
The research instruments contained all pertinent information necessary to facilitate smooth administration. The Excel file was used to record the responses. The analysis and interpretation were done by a registered guidance counselor.
Data was analyzed using JASP version 0.16.40 and summarized through descriptive statistics (Kaur et al., 2018). Additionally, multiple linear regression was performed, which is a widely used statistical procedure for relating a set of two or more variables (Jobson, 1991) or for understanding the effect of explanatory variables (Berry, 2005). It must be noted, however, that before the conduct of multiple linear regression, seven assumptions were checked: the variables investigated were continuous, normally distributed, and without outliers; the relationships of interest, heteroscedasticity, correlation among the influencing determinants, and independence of errors.
To be specific, normality and concerns for outliers were examined in the influencing determinants (sleep disturbances, headaches, gastrointestinal problems, and respiratory infections), together with the outcome variables (depression, anxiety, and stress). Skewness and kurtosis values were all observed to be in the normal range (between −2 and +2 in each of the variables). There were also no outliers, as can be observed from the variable boxplots and histograms. The relationships through the use of scatterplots appeared linear and without concerns for heteroscedasticity. Residual plots showed normal distribution and low correlation (r value ranging from 0.28 to 0.50) among the influencing determinants. Variance Inflation Factors for the models were all seen to be below 5, and Tolerance statistics were all above 0.20, suggesting non-substantial concerns with multicollinearity. All models had acceptable independence of errors (Durbin-Watson = 1.89 for depression, 1.90 for anxiety, and 1.90 for stress), all within the acceptable range of 1.5–2.5.
The proposal for the conduct of the present study was signed by the chairperson of the university's Institutional Ethics Review Committee on August 29, 2023, after the research proposal was found to be ethically sound and compliant with the provisions of the Philippine Data Privacy Act of 2012 and the Philippine National Health Research System Act of 2013 as prescribed by the National Ethical Guidelines for Health and Health-Related Research.
The ethics clearance covered the variables investigated, the target participants, and the instruments used. An informed consent form containing the title of the research, purpose and conduct of the study, nature and extent of involvement, risks and inconveniences, possible benefits for the participants, provision for injury or related illnesses, contact person, voluntariness and participation, and confidentiality and data management was included. Research instruments were administered face-to-face.
Depression, anxiety, and depression together with physical health concerns like sleep disturbances, headaches, gastrointestinal problems, and respiratory infections were investigated, specifically among 976 female undergraduate students enrolled in a state university in the Philippines. Responses were analyzed using descriptive statistics and multiple linear regression. Table 1 presents the descriptive statistics of the subscale scores of the participants in DASS-21; Table 2 presents the descriptive statistics of the subscale scores of the participants in PHQ; Table 3 presents the regression analyses with depression serving as an influencing determinant; Table 4 presents the regression analyses with anxiety as the influencing determinant; and Table 5 presents the regression analyses with stress as the influencing determinant.
Descriptive Statistics of Participants' Subscale Scores in the DASS-21
| M | SD | Min. | Max. | |
|---|---|---|---|---|
| Depression subscale score | 20.76 | 9.32 | 0.00 | 42.00 |
| Anxiety subscale score | 24.03 | 8.72 | 0.00 | 44.00 |
| Stress subscale score | 22.51 | 7.99 | 0.00 | 42.00 |
Descriptive Statistics of Participants' Subscale Scores in the PHQ
| M | SD | Min. | Max. | |
|---|---|---|---|---|
| Sleep disturbances subscale score | 16.09 | 4.27 | 4.00 | 28.00 |
| Headaches subscale score | 15.21 | 4.06 | 3.00 | 21.00 |
| Gastrointestinal problems subscale score | 14.07 | 5.19 | 4.00 | 28.00 |
| Respiratory infections subscale score | 9.59 | 3.35 | 3.00 | 19.00 |
Multiple Linear Regression with Physical Health Concerns as Influencing Determinants of Depression
| Influencing determinants | B | P |
|---|---|---|
| Sleep disturbances | 0.29 | < .00 |
| Headaches | 0.04 | 0.20 |
| Gastrointestinal problems | 0.07 | 0.05 |
| Respiratory infections | 0.18 | < .00 |
Note. R2 = 0.20, F(4,971) = 59.16
Multiple Linear Regression with Physical Health Concerns as Influencing Determinants of Anxiety
| Influencing determinants | B | P |
|---|---|---|
| Sleep disturbances | 0.21 | < .00 |
| Headaches | 0.19 | 0.21 |
| Gastrointestinal problems | 0.15 | 0.05 |
| Respiratory infections | 0.10 | < .00 |
Note. R2 = 0.22, F(4,971) = 67.02
Multiple Linear Regression with Physical Health Concerns as Influencing Determinants of Stress
| Influencing determinants | B | P |
|---|---|---|
| Sleep disturbances | 0.20 | < .00 |
| Headaches | 0.15 | < .00 |
| Gastrointestinal problems | 0.13 | < .00 |
| Respiratory infections | 0.16 | < .00 |
Note. R2 = 0.22, F(4,971) = 64.99
The items with the highest means pertained to being worried, using a lot of nervous energy, and awareness of the dryness in one's mouth. Two of the items were under the anxiety subscale, while one was from the stress subscale. Also, using the subscale scores, it can be said that anxiety had the highest mean, followed by stress and depression, while the most varied based on the standard deviation was depression. With the mean scores as bases, as a group, it can be said that the female undergraduate students experienced severe depression, extremely severe anxiety, and moderate stress. This interpretation was based on the DASS-21 by Lovibond and Lovibond (1995).
The items with the highest means pertained to the experience of headaches. This implies the headaches the most commonly experienced of all the physical health concerns. Unfortunately, subscale scores cannot be compared because of unequal numbers of items. To be specific, the sleep disturbances subscale has four items, the headaches subscale has three items, the gastrointestinal problems increase in anxiety, and a point increase in respiratory infections would mean a 0.10 increase in anxiety. Just like in the previous table, of the three significant influencing determinants, sleep disturbance accounted for the highest point increase in anxiety subscale has four items, and the respiratory infections subscale has three items. However, if comparisons were to be made between the subscales with the same number of items, it can be said that sleep disturbances were more frequently experienced but less varied compared with gastrointestinal problems, while headaches were more frequently experienced and more varied compared with respiratory infections.
Results of regression analysis indicate that the influencing determinants explained 20% of the variance (R2 = 0.20, F(4,971) = 59.16, p < .00). Additionally, sleep disturbances, gastrointestinal problems, and respiratory infections significantly influenced depression. To be specific, a point increase in sleep disturbance would mean a 0.29 increase in depression, a point increase in gastrointestinal problems would mean a 0.07 increase in depression, and a point increase in respiratory infections would mean a 0.18 increase in depression. Of the three significant influencing determinants, sleep disturbances accounted for the highest point increase in depression.
Based on the table, regression analysis suggests that the influencing determinants explained 22% of the variance (R2 = 0.22, F(4,971) = 67.02, p < .00). Three determinants significantly influenced anxiety. A point increase in sleep disturbances would mean a 0.21 increase in anxiety, a point increase in gastrointestinal problems would mean a 0.15 increase in anxiety, and a point increase in respiratory infections would mean a 0.10 increase in anxiety. Just like in the previous table, of the three significant influencing determinants, sleep disturbance accounted for the highest point increase in anxiety.
As presented on the table, regression analysis suggests that the influencing determinants explained 22% of the variance (R2 = 0.22, F(4,971) = 64.99, p < .00). All of the determinants significantly influenced stress. Specifically, a point increase in sleep disturbances would mean a 0.20 increase in stress, a point increase in headaches would mean a 0.15 increase in stress, a point increase in gastrointestinal problems would mean a 0.13 increase in stress, and a point increase in respiratory infections would mean a 0.16 increase in stress. Similar to the previous two tables, of the four influencing determinants, sleep disturbance accounted for the highest point increase in stress.
The present study investigated the influencing role of physical health concerns, particularly sleep disturbances, headaches, gastrointestinal problems, and respiratory infections, in the experience of depression, anxiety, and stress. While previous studies (e.g., Amadu et al., 2024; de Oliveira Viana et al., 2024; Kamruzzaman et al., 2024) documented the prevalence of depression, anxiety, and stress among undergraduate students in different parts of the world, thus making them a global concern, they have not explicitly investigated the influencing role of physical health concerns like sleep disturbances, headaches, gastrointestinal problems, and respiratory infections.
Female undergraduate students in the present study experienced severe depression (M = 20.76, SD = 9.32), extremely severe anxiety (M = 24.03, SD = 8.72), and moderate stress (M = 22.51, SD = 7.99). Depression, anxiety, and stress were measured using the DASS-21. Existing studies together with the present study implied depression, anxiety, and stress concerns among female undergraduate students. For example, a study found that Pakistani female undergraduate students, compared with male undergraduate students, had a high frequency of depression, stress, and anxiety (Jamali et al., 2024). Similarly, Wynter et al. (2021) found that Australian undergraduate students reported moderate to severe symptoms of depression, anxiety, and stress, with females again scoring significantly higher. In addition, increased levels of depression, anxiety, and stress were recorded among Greek female and younger students (Kavvadas et al., 2023), while Blanco et al. (2021) found that 18.1%, 22.8%, and 13.5% presented severe/very severe levels of depression, anxiety, and stress among Spanish undergraduate students, with females reporting an alarming percentage of the experience of major depression and severe/very severe stress. In Croatia, Talapko et al. (2021) found that depression prevalence was at 50.8%, anxiety at 50.9%, and stress at 49.9%, with females having significantly higher levels.
Additionally, regression models tested (R2 = 0.20, F(4,971) = 59.16 for depression, R2 = 0.22, F(4,971) = 67.02 for anxiety, and R2 = 0.22, F(4,971) = 64.99 for stress) were all significant. These models explained the influence of physical health concerns on mental health, which is parallel with existing literature (e.g., Armstrong et al., 2024; Dopelt & Houminer-Klepar, 2024; Nour et al., 2023; Zheng et al., 2024). Thus, it can be said that neglecting physical health can negatively impact mental health (Woffindin, 2023), and interventions focusing on physical health concerns can also greatly alleviate mental health concerns among the female undergraduate students, especially when one recognizes the many demands of collegiate education. To ensure that female undergraduate students thrive during this important stage of their lives, necessary assistance must be provided. In line with this, based on the findings of their study, Kharroubi et al. (2024) state that public health programs and interventions aimed at addressing mental health together with lifestyle behaviors are necessary for student success.
Furthermore, although gastrointestinal problems and respiratory infections significantly influenced depression, anxiety, and stress, sleep disturbances consistently accounted for the higher point increase (B = 0.29 for depression, B = 0.21 for anxiety, and B = 0.20 for stress). This highlights the importance of sleep. Using the meta-analysis of randomized controlled trials on intervention effects of health on mental health together with mental health difficulties, Scott et al. (2021) found that sleep was related to the experience of mental health concerns, with improved sleep associated with improved mental health regardless of the severity. In relation, Blackwelder et al. (2021) found in their study that insufficient sleep was associated with a significant increase in the experience of mental distress, while Lyu et al. (2024) emphasized the need for adequate sleep duration to mitigate mental health concerns. Similarly, sleep has been linked to the overall quality of life among undergraduate students based on the results of the study of Moussa-Chamari et al. (2024). With the lifestyle of the current participants coupled with the demands of undergraduate education, this was understandable and highlights the importance of closely taking into consideration lifestyle changes so as to have better sleep quality. Minimizing time on social media can be one of them, although it is not explored in the present study. For Ramar et al. (2021), the focus should not only be on sleep duration but also on quality, timing, regularity, and even the absence of sleep disorders.
Ultimately, higher education institutions should put a premium on the concerns of students, be they physical or mental, because these concerns can greatly impact their performance. It must be noted that students are not mechanical creatures but individuals with the ability to feel and be affected by their concerns. Student attrition, which is a main concern in higher education institutions, can be combatted by taking bold steps in addressing the concerns of students. One of the actions that can be undertaken in higher education institutions is the crafting of contextualized mental health programs where physical health concerns are also given importance. Physical health concerns may be explored during counseling sessions so that targeted actions can be recommended. Also, the development of materials targeting both physical and mental health wellness can be provided to students so that they will be properly informed. These targeted actions can be instrumental to the success of every student in higher education institutions, which in the long run will guarantee the success of a nation.
The present study emphasized the healthy body-healthy mind connection, where one is as important as the other. Concerns in one area might bleed into the other, making physical well-being components a must in mental health interventions. With the prevalence of mental health concerns among undergraduate students and the global population in general, the present study provided evidence that physical health can serve as a protective factor against depression, anxiety, and stress. The present study has provided additional information needed in crafting contextualized mental health programs both locally and globally.
It must be noted that the present study has some limitations. First and foremost is the use of self-report measures. Thus, it can be assumed that it is possible that what has been reported by the participants of the present study are perceptions and subjective responses. Second, the participants came from a state university in the Philippines. Thus, their experiences may be different from the experiences of those from private institutions. However, despite the limitations of the present study, every effort has been exerted so that the results of the study remain reliable and can serve as bases for necessary courses of action.
The present study added to the pool of knowledge on mental health, particularly in concerns like depression, anxiety, and stress. As revealed in the present study, physical health concerns can serve as influencing determinants in understanding mental health concerns. Thus, taking into consideration physical health in addressing mental health concerns can be an option. Having a thorough understanding of physical health concerns can be used in contextualizing interventions necessary to combat the rise of mental health concerns. A holistic understanding of wellness is always necessary.
In summary, this study highlights the importance of physical wellness in understanding mental health concerns. Therefore, understanding mental health concerns, particularly depression, anxiety, and stress among female undergraduate students, also requires understanding physical health concerns, which is necessary in contextualizing mental health programs.
However, despite the conclusion drawn from the present study, it is still recommended that other variables that may mitigate mental health concerns be investigated, like protective factors, e.g., resilience, self-compassion, and help-seeking behaviours. Also, the conduct of research with a bigger population is suggested. The conduct of parallel studies among undergraduate female students in private institutions is equally recommended. These actions will give a better understanding of physical health and mental health concerns. By including more students with wider geographical distribution, it can be guaranteed that more sweeping conclusions can be made, which can lead to the better crafting of recommendations and targeted interventions.