Health-Promoting Behaviors and Its Relationship With Anxiety, Depression, and Social Support Among Nursing Students in Saudi Arabia: A Cross-Sectional Study.

Objectives: This study aimed to assess the levels and determinants of health-promoting behaviors (HPBs) and their correlations between HPBs, anxiety, depression, and social support among nursing students.

Design and methods: A cross-sectional, correlational study was performed from March to June 2024 with 268 nursing students in the College of Nursing at the University of Hail using a self-structured questionnaire. Data were analyzed using t-test, one-way analysis of variance, Pearson's correlation, and multiple stepwise regression.

Results: The mean score of nursing students on the HPLP-II scale was 2.60 ± 0.47 overall, with the spiritual growth subscale scoring the highest (3.05 ± 056) and physical activity scoring the lowest (2.25 ± 0.75). More than a quarter of the students were classified into the borderline range for anxiety (28.4%) and depression (26.9%). In comparison, 19.4% and 16% of the students experienced anxiety and depression, respectively. There were significant weak negative correlations between the HPBs and anxiety (r = -0.396; p < 0.001) and between social support and anxiety (r = -0.335; p < 0.001). Likewise, there were significant weak negative correlations between HPBs and depression (r = -0.343; p < 0.001) and between social support and depression (r = -0.313; p < 0.001). In contrast, significant weak positive correlations were observed between HPBs and social support (r = 0.354; p < 0.001) and between anxiety and depression (r = 0.380; p < 0.001). Multiple linear regression analysis of factors affecting HPBs, anxiety, depression, and social support showed that the model was significant for all (p = 0.026, p = 0.005, p < 0.001, p = 0.003, respectively).

Conclusion: Although students reported a satisfactory level of HPBs, especially for spiritual growth and social relations, nutrition and physical activity require attention. The presence of anxiety and depression affected a substantial proportion of the students, especially those from lower socioeconomic status, and studying in the early years of the study. Family income, occupation, and education level have been reported to have a significant impact on health outcomes.