Exploring niacin skin flushing response in psychological screening of college students

BACKGROUND: The psychological well-being of college students is a growing concern due to its impact on personal and academic outcomes. Traditional symptom-based scales for psychological health screening are often subjective and prone to misclassification. The niacin skin flushing response (NSFR), a physiologically grounded biomarker, has shown promise in identifying psychiatric conditions. This study explored the application of NSFR as an objective tool for psychological health screening among college students. METHODS: We recruited 633 college freshmen who completed the “College Student Mental Health Crisis Intervention Scale” and underwent the NSFR test. Students identified as at-risk by the scale (n = 191) were further evaluated by psychological counselors and classified as “Counselor-Assessed Normal” (CA-Normal, n = 164) or “Counselor-Assessed AtRisk” (CA-AtRisk, n = 27). NSFR responses, including flushing area and EC50 values, were compared between groups using multiple linear regression models adjusted for covariates. Logistic regression and ROC analysis were employed to assess the discriminative efficacy of NSFR. RESULTS: CA-AtRisk students exhibited blunted NSFR, with significantly higher EC50 values (p = 0.017) and smaller flushing areas at 4, 5, 7, and 8 min (p < 0.05) compared to CA-Normal students. The sum of flushing scores at 4 min with 60 mM AMN demonstrated the best discrimination efficiency (sensitivity = 0.444, specificity = 0.829). Combining NSFR with the scale doubled the positive predictive value (PPV) from 0.141 to 0.300. CONCLUSIONS: NSFR shows potential as an objective adjunct tool for psychological health screening in college students, improving the accuracy of risk identification. Its integration into screening protocols could optimize resource allocation, particularly in settings with limited psychological health services. Further research is needed to validate these findings in larger and more diverse populations.