Psychological Distress in University Students: A Network Analysis of Symptom Interactions and Cross-Cultural Differences

Background: University students consistently report high levels of psychological distress, yet little is known about how symptoms relate to one another in Italian university students and how these patterns may differ across similar populations with different cultural backgrounds, especially when considering the interplay of anxiety and depressive symptoms. Methods: We analyzed baseline data from 922 Italian university students (M_age = 24.9, SD = 5.4; 74.8% female) who completed the Kessler Psychological Distress Scale (K 10), the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), the Insomnia Severity Index (ISI), the World Health Organization Well-Being Index (WHO-5) and the General Health Questionnaire-12 (GHQ-12). A comprehensive psychological distress network including all assessed symptoms was estimated to examine centrality, stability, node predictability and bridging features. Furthermore, a Network Comparison Test (NCT) on a reduced network comprising the PHQ-9 and GAD-7 items was conducted, comparing its structure and global strength with a previously published network of Chinese college freshmen (N = 2,082, M_age = 18.6, SD = 0.9; 60.1% female). Results: In the comprehensive Italian network, worry and worthlessness were the most central symptoms, while concentration problems, sleep complaints, and feelings of failure showed the strongest bridging properties across symptom domains. In the network comparison, cognitive anxiety nodes (“nervousness” and “worry”) were more central in the Italian sample, whereas somatic anxiety nodes (“restlessness”, “irritability”, and “fear/afraid”) were more central in the Chinese network. No depressive symptoms differed significantly between the two networks. Conclusions: Results suggest that worry and feelings of failure were central in the organization of psychological distress in the Italian sample, with difficulty concentrating and sleep problems bridging different symptom domains. When compared with a similar student population, the organization of anxiety symptoms may be more context-dependent than that of depressive symptoms, highlighting the importance of considering cultural background when assessing their co-occurrence.