Depression, anxiety, and sleep problems among Chinese university students enrolled in basketball elective courses: a network psychometric analysis

Background: University students face a substantial mental health burden. Although team sports such as basketball are recognized for their benefits, the symptom-level mechanisms linking depression, anxiety, and sleep disorders within this physically active population remain unclear. Methods: A cross-sectional study was conducted with 2,108 Chinese university students enrolled in basketball elective courses at Jilin University in Changchun province, China. Network analysis was applied to construct symptom networks of depression (PHQ-9), anxiety (GAD-7), and sleep problems (PSQI). Centrality metrics (strength, bridge strength) identified core symptoms and connectors between symptom clusters. Network stability was assessed via bootstrap procedures, and gender differences were examined using Network Comparison Tests. A sensitivity analysis was performed by reconstructing networks after excluding the PHQ3 to assess their influence on network structure. Results: Prevalence rates were 16.08% for anxiety, 19.83% for depression, and 23.34% for sleep problems. In the depression-anxiety network, uncontrollable worry (GAD2) and irritability (GAD6) emerged as core symptoms, while restlessness (GAD5) and irritability (GAD6) functioned as key bridge symptoms. In the tri-domain network incorporating sleep problems, daytime dysfunction (PSQI7) exhibited the highest centrality and bridge strength, linking sleep disturbances to emotional symptoms. Gender comparisons revealed no significant differences in network structure or global strength. The sensitivity analysis confirmed that the overall network topology and key bridge symptoms remained stable after excluding PHQ3. Conclusion: Depression, anxiety, and sleep problems form interconnected symptom networks in basketball elective students, with specific symptoms acting as critical nodes and bridges. Targeted interventions focusing on daytime dysfunction, irritability, and uncontrollable worry may disrupt symptom propagation and improve mental health outcomes in this population.