[The association between unhealthy lifestyle and depressive symptoms, anxiety symptoms, and stress among secondary school students in Jiangsu Province, China].

Objective: To analyze the association between unhealthy lifestyles and depressive symptoms, anxiety symptoms and stress among secondary school students in Jiangsu Province. Methods: From September to November 2023, a multistage stratified cluster random sampling method was used to select secondary school students from 13 districts and cities in Jiangsu Province. A questionnaire survey was conducted on their unhealthy lifestyles (low physical activity, smoking, drinking, internet addiction, poor sleep quality, and unhealthy diet), as well as their depressive symptoms, anxiety symptoms and stress. The multivariate logistic regression model and mixed graph model were used to construct a network and analyze the association between unhealthy lifestyles and depressive symptoms, anxiety symptoms and stress. Results: A total of 81 414 secondary school students were finally included in this study, including 39 725 (48.79%) female students and 41 689 (51.21%) male students. The prevalence of depressive symptoms, anxiety symptoms and stress were 18.55%, 32.09% and 12.91%, respectively. The multivariate logistic regression model showed that after adjusting for age, gender, urban-rural status, residential status, and family type, compared with students without unhealthy lifestyles, students with low physical activity, smoking, alcohol consumption, internet addiction, poor sleep quality, and unhealthy diet had a significantly increased risk of depressive symptoms (OR=1.12, 95%CI:1.07-1.17; OR=1.60, 95%CI: 1.49-1.72; OR=1.79, 95%CI: 1.71-1.88; OR=3.05, 95%CI: 2.77-3.36; OR=6.66, 95%CI: 6.40-6.93; OR=1.29, 95%CI: 1.24-1.34) and a significantly increased risk of anxiety symptoms (OR=1.09, 95%CI: 1.05-1.13; OR=1.42, 95%CI: 1.33-1.52; OR=1.76, 95%CI: 1.69-1.83; OR=2.40, 95%CI: 2.17-2.65; OR=5.79, 95%CI: 5.59-6.00; OR=1.16, 95%CI: 1.12-1.21). Students who smoked, drank alcohol, had internet addiction, and had poor sleep quality had a significantly increased risk of stress (OR=1.49, 95%CI: 1.38-1.61; OR=1.79, 95%CI: 1.70-1.89; OR=2.25, 95%CI: 2.04-2.48; OR=6.74, 95%CI: 6.43-7.06). The node with poor sleep quality (bridge strength=0.48) in the network constructed by the mixed graph model had the strongest centrality of the bridge connecting unhealthy lifestyles with depressive symptoms, anxiety symptoms and stress. Conclusion: Low physical activity, smoking, alcohol consumption, internet addiction, poor sleep quality, and unhealthy diet increase the risk of depressive symptoms and anxiety symptoms among Jiangsu Province secondary school students. Smoking, alcohol consumption, internet addiction, and poor sleep quality increase the risk of stress among Jiangsu Province secondary school students. Sleep quality is an important intervention target for Jiangsu Province secondary school students to alleviate their negative emotions.