- Mild depressive and anxiety symptoms were highly prevalent; moderate-to-severe symptoms affected a clinically significant minority.
- A temporal peak in 2024 showed higher PHQ-9 scores, and self-harm ideation remained persistently elevated into 2025, indicating sustained suicide risk.
- Harmonised three-wave data demonstrated high PHQ-9 and GAD-7 reliability and convergence, providing a robust foundation for longitudinal modelling and evidence-based interventions.
Front Public Health. 2026 Sep 15;14:1917300. doi: 10.3389/fpubh.2026.1917300. eCollection 2026.
ABSTRACT
BACKGROUND: Depression and anxiety symptoms are prevalent among college students and significantly affect their academic performance, interpersonal functioning, and long-term well-being. Repeated cross-sectional surveys can reveal temporal variations in symptom burden, yet rigorous data harmonization is essential to ensure valid cross-year comparisons. This study aimed to harmonize three waves of questionnaire survey data and provide a comprehensive descriptive summary of depressive and anxiety symptoms among Chinese college students.
METHODS: Questionnaire submissions were recorded from 9 November 2023 to 3 January 2024, 14 May to 14 June 2024, and 7 April to 5 May 2025. Student identifiers were used to identify repeated within-wave submissions and overlap across administrations. After retaining the earliest response per student within each administration, 4,236 records remained (2023: 1,998; 2024: 1,743; 2025: 495). Depressive and anxiety symptoms were measured using the PHQ-9 and GAD-7. Inter-administration comparisons used Kruskal-Wallis and chi-square tests with effect sizes. Generalized estimating equations accounted for repeated observations of the same student. Internal consistency, PHQ-9/GAD-7 convergence, and multivariable correlates of PHQ-9 Item 9 endorsement were evaluated.
RESULTS: The analytic dataset included 4,236 wave-specific records from 2,782 unique students; 240 students participated in all three administrations. Overall mean PHQ-9 and GAD-7 scores were 5.08 ± 4.08 and 3.21 ± 3.70, respectively. Differences across administrations were statistically significant (PHQ-9 epsilon-squared = 0.006; GAD-7 epsilon-squared = 0.007). In age- and sex-adjusted GEE models, the 2024 administration had higher PHQ-9 scores than 2023 (adjusted mean difference 0.49, 95% CI 0.24-0.74), whereas the 2025 difference was not significant. PHQ-9 and GAD-7 demonstrated high internal consistency (alpha = 0.890 and 0.937) and strong convergence (Spearman rho = 0.798).
CONCLUSION: Mild depressive and anxiety symptoms were highly prevalent in this college cohort, while moderate-to-severe symptoms affected a clinically significant minority. The temporal peak in 2024 and the persistent elevation of self-harm ideation in 2025, underscore the necessity of a tiered campus mental health strategy and the critical importance of independent, continuous suicide risk surveillance. The harmonized dataset provides a robust foundation for future longitudinal risk-factor modeling and evidence-based intervention planning.
PMID:42812166 | PMC:PMC13619404 | DOI:10.3389/fpubh.2026.1917300
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