The extra burden: differential somatization-moderated mediation models of anxiety, depression, and insomnia on quality of life through abnormal illness behavior in Chinese college students.

BACKGROUND

Psychological distress (anxiety, depression, insomnia) is prevalent among college students, often co-occurring with somatization and abnormal illness behavior (AIB) to impair quality of life (QoL). This study aims to construct moderated mediation models exploring the association between psychological distress and QoL through AIB, and examine the moderating role of somatization, providing evidence for targeted mental health interventions.

METHODS

A cross-sectional survey of 7,529 Chinese college students was conducted. Anxiety, depression, and insomnia were treated as predictors, AIB as the mediator, somatization as the moderator, and QoL (mental component summary [MCS] and physical component summary [PCS]) as the outcomes.

RESULTS

After adjusting for selected covariates, anxiety, depression, and insomnia showed significant negative direct effects on PCS (β = -0.0553, 95%CI: -0.0995 to -0.0111; β = -0.1034, 95%CI: -0.1428 to -0.0641; β = -0.3559, 95%CI: -0.3932 to -0.3185) and MCS (β = -0.5321, 95%CI: -0.5819 to -0.4823; β = -0.4799, 95%CI: -0.5243 to -0.4355; β = -0.4818, 95%CI: -0.5247 to -0.4389), all p < 0.05. AIB significantly mediated the associations of anxiety, depression, and insomnia with PCS and MCS. Somatization moderated all indirect effects: conditional indirect effects were significantly negative at low, moderate, and high levels of somatization, and the negative mediating effects strengthened as somatization increased.

CONCLUSIONS

AIB mediated the relationship between psychological distress and QoL, and this mediation was moderated by somatization. These findings clarify the psychosomatic correlates of QoL impairment in a non-Western population, informing culturally tailored college mental health strategies and providing implications for clinical assessment and intervention.