Unhealthy behaviors and psychological distress among higher education students in a 3-year follow-up

Abstract Background Unhealthy behaviors have been considered as risk factors for mental health problems. However, mental health problems can also impact health behaviors. This longitudinal study examined bidirectional associations between unhealthy behaviors and their changes over a 3-year follow-up, and psychological distress (PD) among Finnish higher education students. Methods Individual follow-up survey data, collected in 2021 and 2024, of higher education students in Finland (n = 1089, aged 21-34 y) were used. Unhealthy behaviors included physical inactivity, irregular fruit and vegetable (F&V) intake, excessive alcohol use, and any use of nicotine products. Mental Health Inventory (MHI-5, score < =60) was used to indicate PD. Odds ratios (ORs) were estimated with logistic regression models: for PD in 2024 according to transitions in health behaviors between 2021-2024, and for unhealthy behaviors in 2024 according to transitions in PD between 2021-2024. Models were controlled for age, sex, education sector, uncertain financial situation, and baseline status of corresponding outcome. Results Of the students, 49% in 2021 and 43% in 2024 experienced PD. Compared with the maintained healthy behavior, those having maintained unhealthy behaviors, such as physical inactivity (OR = 1.62; p < 0.05), irregular F&V intake (OR = 2.61; p < 0.01), use of nicotine products (OR = 1.97; p < 0.01) or unfavorable changes in F&V intake (OR = 2.61; p < 0.01), were more prone to PD at the follow-up. In turn, the physical inactivity (OR = 1.98; p < 0.001) and irregular F&V (OR = 1.74; p < 0.01) were more common at the follow-up among those with maintained PD compared to those without PD. Moreover, the incidence of PD during follow-up was associated with irregular F&V intake (OR = 2.15; p < 0.01). Conclusions Our findings highlight a bidirectional association: maintained unhealthy behaviors increase the risk of PD, whereas enduring or emerging PD may predispose individuals to adopt or maintain unhealthy behaviors. Key messages • Bidirectional association between lifestyle and psychological distress underscores the need of addressing both mental health and lifestyle simultaneously to enhance the well-being of students. • Ensuring equal opportunities to adopt and maintain healthy lifestyles, and recognition and treatment of mental health problems can support students’ ability to study and finish their education.