Not all distress is the same: profiles of stress, anxiety, and depression among university students

Introduction: The psychological distress among university students has become more and more common, but the manifestations at the individual level are very heterogeneous. This study was guided by cognitive appraisal theory, which took a personcentered approach to investigate joint patterns of perceived stress, anxiety, and depression in university students and their relationships with sleep quality. Methods: A total of 764 undergraduate students from a comprehensive university in central China participated in this study. Latent profile analysis was conducted to classify distinct psychological distress profiles of participants. Demographic characteristics and sleep quality indicators were further analyzed as relevant correlates of the identified profiles. Results: Three latent profiles included a Resilient profile (41.0%) with low stress appraisals and emotional symptoms, an Uncontrollability-Depressive profile (47.9%) with high uncontrollability appraisals and depressive symptoms, and a Tension-Anxious profile (11.1%) with high tension appraisals and anxiety symptoms. These profiles varied not only in terms of the severity of distress overall, but also in terms of configurational patterns of stress appraisals and emotional reactions. Additional analyses indicated that the quality of sleep strongly predicted membership in a particular profile and functional outcomes related to sleep, and worse sleep always corresponded to higher-risk profiles. On the contrary, there were no independent predictive effects of demographic variables after controlling for the effect of sleep quality. Discussion: This study emphasizes the heterogeneity of psychological distress among university students and the importance of a profile-based approach by combining cognitive appraisal processes and functional outcomes. The results highlight the configurational heterogeneity of student distress and imply sleep as an effective and cost-effective stratified screening and early intervention tool.