CORRELATION OF PSYCHOLOGICAL MALADJUSTMENT, SOCIAL SUPPORT AND PSYCHOSOMATIC HEALTH IN FRESHMAN AMONG COLLEGE STUDENTS

 

Lingming Kong ¹ , Xiaoli Zhu ¹,  Liyi Zhang ¹

 

¹ Prevention and Treatment Center for Psychological Diseases, No.904 Hospital of PLA, Changzhou 213003, Jiangsu, China

 

1. INTRODUCTION

With the introduction of the biological-psychological-social medical model, when considering individuals’ health, we should take account of the perfect combined condition of body, mental and society. Now, Zhang et al. (2021). And Li et al. (2021) argued that the current research is mainly on the correlation between mental health and social support in college students, but few research have been reported on psychosomatic health and associated factors.

Psychosomatic disorder generally refers to a medical disorder (including conversion disorder, somatization disorder, and hypochondriasis) that is caused by psychological factors, The fundamental commonality of all these somatoform disorders is the experience of physical symptoms that are not fully explained by a medical condition or by another mental disorder and cause significant functional impairment in life realms such as family, career, and social activity. Studies have showed that psychosomatic health was associated with a variety of factors, in which social support and maladjustment are important factors. Social support could reduce the body's response to social stress so that it can improve psychosomatic health. Studies have shown that social support can reduce cardiovascular complications and neuroendocrine responses caused by stress so as to benefit the psychosomatic health.      Eisenberger et al. (2007) and Lee et al. (2012) have shown that high levels of social support could reduce cortisol responses caused by the stress through the mediation of dorsal anterior cingulate and Brodmann 8 (BA8) area, decrease the body damage caused by too strong stressed neuroendocrine response, improve the level of the psychosomatic health, and give solid evidence of neurobiological mechanism for the mediation role of social support. In one study, Nyarko et al. (2020) also suggested that social support played buffering role between stressful life-events and depressive and psychological distress symptoms.

Adaptability is an important element of mental diathesis for keeping health under life stress. Martin and Lysaker (2021), Chen et al. (2022), Carey and Richards (2014) reported that academic stress, economic burden, interpersonal problems, maladjustment of daily life habit and other environmental stress stimuli in freshmen increased the chance of depression, anxiety, distress, which results into the problems of their emotional disturbance, behaviour manner and environmental adaptation. Besides, some studies found out the individual adaptability was related to its cultural orientation and personal characteristics. Under stressed condition, Szabó et al. (2020), Zou et al. (2013) and Sherry et al. (2013) found that armed police soldiers holding a horizontal collectivism culture orientation may be difficult to adapt to the forces’ cultural environment. Chang et al. (2015), Marco and Alonso (2019), Ooi et al. (2017) and McGarrigle et al. (2020) confirmed maladjustment can make us face psychological and physical symptoms such as depression, anxiety, chronic pain. These factors are not only jeopardizing psychosomatic health, but also resulting into the decline of academic performance, which can easily lead to attrition.     

On one hand, freshmen among college students need to cope with the psychological and physical discomfort in adaptive process of new life; On the other hand, almost all of them firstly leave home, often experience a lack of emotional support from family what can increase the individual's feelings of loneliness and alienation. That often induces mood disorders such as anxiety and depression. In this complex situation, psychosomatic health of freshmen is more vulnerable to be damaged, can furtherly cause all kinds of psychosomatic disorders.

This paper analyses freshmen’s psychosomatic health status and its association of social support, maladjustment, and relevant factors in comprehensive way. By this, we try to build a psychosomatic health and medical support system for health maintenance and disease prevention in freshman among college students.

 

2. MATERIALS AND METHODS

2.1. Participants

Using random cluster sampling method, to answer in a continuous, random, random response way. If the answer tablet is not complete, it will be deleted. Study group: 2790 freshmen (male: 1431, female: 1539) from 4 universities in Changzhou with average age of 18.91±3.39 were recruited. Control group：2790 sophomore, junior college students (male: 1342, female: 1448) as control group were recruited at the same time in the same area.

 On the age, gender, there is no significant difference（P>0.05）. Exclude the ones with a history of mental illness, substance abuse.

 

2.2. Assessment instruments

Chinese Psychosomatic Health Scale (CPHS) includes 134 items, is composed of 2 dimensions, 11 factors, including somatic disorder (eye & ear, respiratory system, cardiovascular system, digestive system, skeletal muscle, skin, reproductive & endocrine, nervous system) and psychological disorder (anxiety, depression, psychoticism). Cronbach’ α coefficient of CPHS and factors in this study is 0.63～0.81.

Maladjustment Self-Assessment Scale (MSAS) had 4 factors, respectively Behaviour Problems (BP), Emotional Adjustment (EA), Interpersonal relationship (IR), Environmental adaptation (ED). The Scale contains 40 items. The higher the score indicates worse maladjustment degree. Cronbach’α coefficient of MSAS and factors in this study is 0.71～0.92.

Chinese Social Support Scale (CSSS) with 18 entries, including three factors—Subjective Support (SS), Objective Support (OS), Support Degree of Use (SDU), The higher the score indicated lower degree of social support. Cronbach’α coefficient of CSSS and factors in this study is 0.62～0.87.

 

2.3. Statistical analysis

Excel 2013 was used to set up a database. t test, Pearson correlation analysis and multiple stepwise regression analysis on SPSS17.0 were carried out.

 

3. RESULTS

3.1. Comparison of the psychosomatic health between study group and control group

The scores of respiratory systems, cardiovascular system, digestive system, skeletal muscle, skin, reproductive and endocrine, nervous system, anxiety, depression, psychoticism except eye & ear are higher than control group Table 1.

Table 1

Table 1 Comparison for Factors of CPHS Between Study Group and Control Group(±s)
Factors	Study Group(n=2790)	Control Group(n=2790)	t	P
Eye & Ear	1.56±1.45	1.55±1.09	-0.897	0.231
Respiratory System	0.88±1.39	0.76±1.13	3.500	0.000
Cardiovascular System	0.99±1.49	0.50±1.07	13.470	0.000
Digestive System	1.52±2.01	1.39±1.12	2.694	0.007
Skeletal Muscle	0.87±1.24	0.67±1.11	6.734	0.000
Skin	1.09±1.47	0.67±1.15	11.837	0.000
Reproductive & Endocrine	1.26±1.45	1.05±1.26	5.827	0.000
Nervous System	1.51±1.17	1.43±1.76	1.909	0.006
Anxiety	2.58±2.61	2.13±2.41	7.066	0.000
Depression	2.10±2.40	1.40±2.02	11.891	0.000
Psychoticism	4.10±3.99	3.11±3.43	10.152	0.000

 

3.2. Correlation analysis of all factors of psychosomatic health and maladjustment and social support in study group

Pearson’s correlation analysis show that factors of psychosomatic health positively correlated with most factors of MSAS, CSSS Table 2.

Table 2

Table 2 Correlation Analysis for Factors of CPHS and MSAS, CSSS in Study Group(R)
Factors	SS	OS	SDU	BP	EA	IR	ED
Eye & Ear	0.271*	0.334**	0.350**	0.295**	0.228*	0.296**	0.263*
Respiratory System	0.413**	0.425**	0.369**	0.329**	0.253*	0.336**	0.295**
Cardiovascular System	0.563**	0.682**	0.350**	0.292**	0.238*	0.320**	0.262*
Digestive System	0.619**	0.335**	0.277*	0.212*	0.251*	0.220*	0.212*
Skeletal Muscle	0.360**	0.393**	0.325**	0.271*	0.232*	0.263*	0.264*
Skin	0.290**	0.227*	0.322**	0.275*	0.238**	0.273*	0.256*
Reproductive & Endocrine	0.131	0.043	0.336**	0.326**	0.286**	0.335**	0.307**
Nervous System	0.202*	0.316**	0.365**	0.323**	0.240*	0.301**	0.268*
Anxiety	0.427**	0.411**	0.469**	0.411**	0.368**	0.455**	0.348**
Depression	0.450**	0.02	0.500**	0.464**	0.414**	0.496**	0.409**
Psychoticism	0.354**	0.255*	0.488**	0.380**	0.349**	0.423**	0.348**
Notes：*P<0.05, **P<0.01

 

3.3. Multivariate stepwise regression analysis for influencing factors of psychosomatic health in study group

With total of CPHS as dependent variable, with each factor of MSAS (BP, EA, IR, ED), CSSS (SS, OS, SDU) as variable，to carry on multivariate regression analysis. The result shows that BP, IR, ED, SS, SDU, age, etc. enter into the regression equation. The regression parameter equation is the total score of psychosomatic health=-6.646+0.562x1+0.709x2+0.511x3+0.633x4+0.474x5 (F=218.980, P<0.01). In them, x1~x6represent respectively: IR, BP, ED, SS, SDU Table 3.

  Table 3

Table 3 Multivariate Stepwise Regression Analysis for Influencing Factors of Psychosomatic Health in Study Group
Variable	B value	Standardization Regression Coefficient	t value	P value
BP	0.562	0.150	5.936	0.000
IR	0.709	0.166	6.250	0.000
ED	0.511	0.112	4.712	0.000
SS	0.633	0.155	6.045	0.000
SDU	0.474	0.219	4.355	0.004

 

 

4. DISCUSSION

Bortes et al. (2021) and McGarrigle et al. (2020) have identified that psychosomatic health is often associated with academic performance and psychosocial function, how to keep psychosomatic health is an important issue for all freshmen. The mental health problem of college students is a prominent problem. The causes of mental health problem and somatic symptom of college students are closely related to psychological characteristic of specific age group and environment changes, among them, Freshman are most susceptible to psychosomatic disorder. This study confirmed that scores of psychological disorders (anxiety, depression, psychoticism etc.) and of somatic disorder (respiratory system, cardiovascular system, digestive system, skeletal muscle, skin, reproductive and endocrine, nervous system) are higher than control group. all factors of CPHS had positive correlation with most factors of MSAS, CSSS; the stepwise regression analysis showed that behavioural problem, interpersonal relationship, environmental adaptation, subjective support, support degree of use entered into the regression equation. These results indicate that there is more psychosomatic disorder which associated with maladjustment and social support in freshman.

New learning model, lack or unstable of interpersonal relation, life habit or climate adaption, self-management failure are likely to be stressors for the freshman, The more the stressors, the more difficult for psychological-physical system to adapt, including behaviour problem, emotional disorder, sleep disorder, which finally result into psychosomatic health problem. Aghamohammadi et al. (2021) reported Heat stress significantly affect psychosomatic pain, psychological anxiety, and somatization related symptoms; Knight et al. (2021) argued mechanism of effects of stress on psychosomatic health that stress alterations in diurnal cortisol are associated with heightened systemic inflammation. In particular, higher levels of perceived stress and traumatic life events were associated with flatter diurnal cortisol slopes, which in turn were associated with increased levels of inflammatory biomarkers. And furtherly proposes the hypothesis that the wear and tear of the body caused by repeated exposure to stress is regulated by an interconnected network of mediators, including stress hormones and immune markers.

Dangelmaier et al. (2006) proposed that the most important factor is social support among the social psychological stimulating pathogenic. Liu et al. (2022) noted social support is defined that when an individual is in stress, he can get material support and spiritual resources from family, friends, or colleagues. In previous study of Kunst et al. (2021), Tas et al. (2018) and Wen et al. (2000), have verified that social support is an intervening variable affecting the stress response result, in common, it reduces stress reaction, including heart rate variability, cortisol response. It is negative correlative with the stress caused by the reaction of body and mind. So, the social support higher, the stress responded less, the psychosomatic health got improvement furtherly. Social support network is helpful for an individual before a stressed event occurred. He can obtain and develop the foresight and ability to cope with life event. Zhang et al. (2007) found effective social support can enhance the ability of tolerance and get rid of the tense situation. Mental ability to adapt is a comprehensive response of a person’s physical power, mentality to then and character qualities etc. It shows an individual’s psychological activity ability.

 

 

5. CONCLUSION

The psychosomatic health in freshman among college students is generally worse than those of the controls. Behavioural problem, interpersonal relationship, environmental adaptation, subjective support, support degree of use are associative factors predictive factors.

 

CONFLICT OF INTERESTS

None. 

 

ACKNOWLEDGMENTS

The authors would like to thank all participants and Sheng-dong Chen for his help of manuscript revision.

 

REFERENCES

Aghamohammadi, N., Fong, C. S., Idrus, M. H. M., Ramakreshnan, M., Sulaiman, N. M. (2021). Environmental Heat-Related Health Symptoms Among Community in a Tropical city. Science of the Total Environment, 782(15). https://doi.org/10.1016/j.scitotenv.2021.146611.

Bortes, C., Landstedt, E., & Strandh, M. (2021). Psychotropic Medication Use and Academic Performance in Adolescence : A Cross-Lagged Path Analysis. J Adolesc, 91(1), 25-34. https://doi.org/10.1016/j.adolescence.2021.07.003.

Carey, D. C., &Richards, M. H. (2014). Exposure to Community Violence and Social Maladjustment Among Urban African American Youth. J Adolesc, 37(7), 1161-1170. https://doi.org/10.1016/j.adolescence.2014.07.021.

Chang, E. C., Muyan, M., & Hirsch, J.K. (2015). Loneliness, Positive Life Events, and Psychological Maladjustment : When Good Things Happen, Even Lonely People Feel Better. Pers Individ Dif, 86, 150-155. https://doi.org/10.1016/j.paid.2015.06.016.

Chen, Y., Buggy, C., Roe, M., Sripaiboonkij, P., Drummond, A., & Perrotta, C. (2022). Worker Adaptation Behaviours and Mental Health Impacts in Irish Workplaces Arising from Covid-19 - Observations of Osh Professionals. Safety and Health at Work, 13, S167. https://doi.org/10.1016/j.shaw.2021.12.1273.

Dangelmaier, R. E., Docherty, N. M., & Akamatsu, T. J. (2006). Psychosis Proneness, Coping, and Perceptions of Social Support. American Journal of Orthopsychiatry, 76(1), 13–17. https://doi.org/10.1037/0002-9432.76.1.13.

Eisenberger, N. I., Taylor, S. E., Gable, S. L., & Hilmert, C. J., Lieberman, M. D. (2007). Neural Pathways Link Social Support To Attenuated Neuroendocrine Stress Responses. Neuroimage, 35(4), 1601-1612. https://doi.org/10.1016/j.neuroimage.2007.01.038.

Knight, E. L., Jiang, Y. P., Rodriguez-Stanley, J., Almeida, D. M., Engeland, C. G., & Zilioli, S. (2021). Perceived Stress is Linked to Heightened Biomarkers of Inflammation Via Diurnal Cortisol in a National Sample of Adults. Brain, Behavior, and Immunity, 93, 206-213. https://doi.org/10.1016/j.bbi.2021.01.015.

Kunst, L. E., Bekker, M. H. J., Maas, J., van Assen, M. A. L. M., Duijndam, S., Riem, M. M. E. (2021). The Role of Autonomy-Connectedness in Stress-Modulating Effects of Social Support in Women : An Experimental Study Using a Virtual Trier Social Stress Test. International Journal of Psychophysiology, 170, 198-209. https://doi.org/10.1016/j.ijpsycho.2021.10.013.

Lee, Y. S., Suchda, S., & Wylie-Rosrtt, J. (2012). Perceived Social Support, Coping Styles, and Chinese Immigrants' Cardiovascular Responses to Stress. Int J Behav Med, 19, 174-185. https://doi.org/10.1007/s12529-011-9156-7.

Li, N., Li, S. Y., & Fan, L. Y. (2021). Risk Factors of Psychological Disorders After the Covid-19 Outbreak : The Mediating Role of Social Support and Emotional Intelligence. The Journal of Adolescent Health, 69(5), 696-704. https://doi.org/10.1016/j.jadohealth.2021.07.018.

Liu, C. Q., Luo, D. Y., Zhou, Y., Zhang, G. N., Feng, X., Wang, Z. H., Chen, J. N., & Bi, Q. L. (2022). Optimism and Subjective Well-Being in Nursing Home Older Adults : The Mediating Roles of Gratitude and Social Support. Geriatric Nursing, 47, 232-238. https://doi.org/10.1016/j.gerinurse.2022.07.020.

MPsych, J. L., Mellor, A., Jobson, L., & Drummond, S. P. A. (2019). Prevalence of Sleep Disturbance and its Relationships with Mental Health and Psychosocial Issues in Refugees and Asylum Seekers Attending Psychological Services In Australia. Sleep Health, 5(4), 335-343. https://doi.org/10.1016/j.sleh.2019.06.002.

Marco, J. H., & Alonso, S. (2019). Meaning in Life Buffers the Association Between Clinical Anxiety and Global Maladjustment in Participants With Common Mental Disorders on Sick Leave. Psychiatry Research, 271, 548-553. https://doi.org/10.1016/j.psychres.2018.12.027.

Martin, A. M. S., & Lysaker, P. H. (2021). Metacognition, Adaptation, and Mental Health. Biological Psychiatry, 91(8), e31-e32. https://doi.org/10.1016/j.biopsych.2021.09.028.

McGarrigle, L., Wesson, C., DeAmicis, L., Connoly, S., Ferreira, N. (2020). Psychological Mediators in the Relationship Between Paediatric Chronic Pain and Adjustment : An Investigation of Acceptance, Catastrophising and Kinesiophobia. Journal of Contextual Behavioral Science, 18, 294-305. https://doi.org/10.1016/j.jcbs.2020.10.009.

Nyarko, F., Peltonen, K., Kangaslampi, S., & Punamäki-Gitai, R. L. (2020). How Stressful Life Events and Violence are Related to Mental Health : The Protective Role of Social Relations in African Context. Heliyon, 6(8), e04629. https://doi.org/10.1016/j.heliyon.2020.e04629.

Ooi, L. L., Nocita, G., Coplan, R. J., Zhu, J. J., & Rose-Krasnord, L. (2017). Beyond Bashful : Examining Links Between Social Anxiety and Young Children's Socio-Emotional and School Adjustment. Early Childhood Research Quarterly, 41, 74-83. https://doi.org/10.1016/j.ecresq.2017.06.003.

Sherry, S. B., MacKinnon, A. L., Fossum, K. L., Antony, M. M., Stewart, S. H., Sherry, D. L., Nealis, L. J., & Mushquash, A. R. (2013). Perfectionism, Discrepancies, and Depression : Testing the Perfectionism Social Disconnection Model in a Short-Term, Four-Wave Longitudinal Study. Personality and Individual Differences, 54(6), 692-697. https://doi.org/10.1016/j.paid.2012.11.017.

Szabó, Á., Papp, Z. Z., & Luu LAN. (2020). Social Contact Configurations of International Students at School and Outside of School : Implications for Acculturation Orientations and Psychological Adjustment. International Journal of Intercultural Relations, 77, 69-82. https://doi.org/10.1016/j.ijintrel.2020.05.001.

Tas, C., Brown, E. C., Eskikurt, G., Irmak, G., Aydın, O., Esen-Danaci, A., & Brüne, M. (2018). Cortisol Response to Stress in Schizophrenia : Associations with Oxytocin, Social Support and Social Functioning. Psychiatry Research, 270, 1047-1052. https://doi.org/10.1016/j.psychres.2018.05.011.

Wen, W. S., Wang, Y. Q., Zhao, G. Q., & Sun, J. F. (2000). Research on the Relationship Between Social Support, Psychological Control and Psychological Health. Chin Mental Health J, 14, 258-260.   

Zhang, X., Huang, P. F., Li, B. Q., Xu, W. J., Li, W., & Zhou, B. (2021). The Influence of Interpersonal Relationships on School Adaptation Among Chinese University Students During Covid-19 Control Period : Multiple Mediating Roles of Social Support and Resilience. Journal of Affective Disorders, 285(1), 97-104. https://doi.org/10.1016/j.jad.2021.06.020.

Zhang, X., Norris, S. L., & Gregg, E. W. (2007). Social Support and Mortality Among Older Persons with Diabetes. Diabetes Educ, 33(2), 273. https://doi.org/10.1177/0145721707299265.

Zou, T., Wei, H., Chen, J., & Fu, H. H. (2013). Relationship of Maladjustment to Cultural Orientation and Stress in Armed Police Soldiers. Chin Mental Health J, 27, 232-235.