Social Capital, Ecological Context, and Mental Health Among Medical and Health-Sciences University Students: A Multilevel Study Across 20 Chinese Cities.

Abstract

Objectives: This study examines how social capital - including its cognitive, participatory, and relational dimensions - and the ecological economic context are associated with probable mental disorders among Chinese university students.

Methods: A cross-sectional multilevel survey was conducted among 5,025 undergraduates from 22 universities across 20 cities in mainland China. Probable mental disorder was screen-identified using the CHQ-12, a screening (not diagnostic) instrument, and social capital was measured using the 12-item SCQ, which captures cognitive, participatory, and relational dimensions; both an overall index and dimension-specific multilevel models were estimated. Three-level (individual-university-region) multilevel logistic regression models were used to estimate associations with individual-, institutional-, and city-level factors.

Results: The prevalence of screen-positive probable mental disorder was 27.2% (95% CI: 24.7%-29.7%). Higher overall social capital was associated with lower odds of probable mental disorder in a graded fashion (highest vs. lowest category OR = 0.25, 95% CI: 0.18-0.35). Among dimensions, relational social capital showed the strongest and most stable inverse association (≥ 2.0 vs. < 1.8: OR = 0.38, 95% CI: 0.25-0.58), followed by cognitive social capital, whereas the association for participatory social capital did not persist when all dimensions were modelled jointly. Students at lower-ranked universities reported lower odds (OR = 0.47, 95% CI: 0.40-0.56) than those at the highest-ranked institutions. Higher home-region GDP per capita was associated with lower odds of probable mental disorder (OR = 0.69, 95% CI: 0.62-0.76), whereas university-city GDP per capita was not significantly associated with probable mental disorder.

Conclusions: Social capital - and its relational dimension in particular - university type, and regional economic development are each independently associated with probable mental disorder among university students. Multilevel social and structural contexts should be considered in designing mental health interventions in higher education.