Psychological distress and lifestyle behaviour of undergraduate university students: implications for health promotion

Poor diet, physical inactivity, tobacco smoking and alcohol consumption are known risk factors for chronic disease and premature mortality. These behaviours are frequently reported among higher education students and may be linked to psychological distress, which is also problematic particularly for students on programmes with practical components such as nursing and teaching. Understanding how risk behaviours aggregate and relate to psychological distress and coping among this population is important for health promotion. A cross-sectional survey examined lifestyle behaviours (Lifestyle Behaviour Questionnaire) and their relationship to psychological distress (General Health Questionnaire (GHQ)1 and coping processes (Ways of Coping Questionnaire (WOC);2 among a total sample of undergraduate nursing/midwifery and teacher education students (n=1,577) in a university in Ireland. The response rate was 71% of the total sample. The respondents were registered on nursing/midwifery (36.5%) and teacher education (63.5%) programmes. Of these, 53.1% were female, most were under the age of 26(90.5%) and single (89.7%).Health risk behaviours were common, including alcohol consumption (93.2%), unhealthy diet (26.3%), physical inactivity (26%), tobacco smoking (17%), cannabis use (11.6%) and significant psychological stress (41.9%). Females were more distressed than males (p=0.0001). Nursing students were more distressed than teacher education students (p=0.0027). Bivariate analyses identified strong links between lifestyle behaviours and demographic characteristics including gender, age, programme of study and place of residence. Multivariate logistic regressions confirmed the relationships between risk behaviours, demographic characteristics, distress and coping. Compared with males, females had lower levels of physical activity (OR=1.58 for females) and consumed less alcohol (OR=1.85 for males). Younger students were more likely to eat convenience food (OR=1.67) than older students. Nursing/midwifery students were less physically active (OR=1.75) and smoked more (OR=2.48) than teacher education students. Those who did not enjoy their programme were more likely to drink alcohol (OR=1.60). Compared with students who worked full time, those who worked part-time, those financially supported by their families or grant-aided had healthier diets (OR=0.42 and 0.35, respectively) but were less physically active (OR=2.44 and 2.16, respectively). Conversely, students who worked part-time consumed more alcohol than those with grant or family support (OR=2.07). High psychological stress scores were correlated with poor diet (OR=1.03), increased consumption of convenience foods (OR=1.04), physical inactivity (OR=1.05) and tobacco smoking (OR=1.04). Passive coping strategies were correlated with poor diet (OR=1.55) and eating convenience food (OR=1.62). Those who mostly used escape avoidance coping were more likely to drink alcohol (OR=2.13) and have lower levels of physical activity (OR=1.84). Exposure to any unhealthy behaviour increased the risk for other risk behaviours. For example those who smoked tobacco had an increased risk of poor diet (OR=1.65), low levels of physical activity (OR=1.54) and alcohol consumption (OR=1.56). Cluster analysis identified a tendency for students to cluster into two groups: those with risk behaviours (n=733) and those with positive health behaviours (n=379). The group with risk behaviours had high psychological distress and used mostly passive coping strategies such as escape avoidance. The group with positive health behaviours comprised students who reported a healthy diet, regular physical activity and who did not use substances (tobacco, alcohol, cannabis). The potential multiplicative effect of these risks on students’ health and subsequently on their academic performance is a concern. As these students are the nurses and teachers of the future, their risk behaviours, elevated psychological distress and poor coping also raise concerns regarding their roles as future health educators/ promoters. Attention to promotion of health and wellbeing among this population is essential.