Self-Care mediates the Effect of Psychological Distress on the Subjective Well-Being and Quality of Life among University Students

Background: University life involves several exposures to risk factors and often coincides with "emerging adulthood," a period characterized by significant change and instability. Furthermore, the COVID-19 pandemic introduced additional lifestyle changes (e.g., a shift to virtual classes, isolation measures, and social distancing) that exacerbated trends in perceived stress, anxiety, depression, and somatization within this subpopulation. This study aimed to assess how university students' health confidence might influence their perception of well-being and mediate their experiences of stress, psychological distress, and somatic symptoms. Methods: A sample of 1113 university students with a mean age of 19.58 years (SD = 3.22), participated in an online survey that gathered data on academic, sociodemographic characteristics, and the following measures: perceived stress scale (M = 13.12, SD = 3.22), Patient Health Questionnaire 4 items (M = 3.44, SD = 2.55), and Patient Health Questionnaire 15 items (M = 4.30, SD = 2.86), as well as Health Confidence Score (M = 76.31, SD = 15.85), WHO Well-Being Index (M = 8.39, SD = 2.44), and Quality of Life Index Spanish version (M = 14.24, SD = 5.04). Path analysis was employed to examine the total, direct, and indirect effects among variables. Results: The model demonstrated excellent fit indices and confirmed the study hypotheses. Stress, anxious, depressive, and somatic symptomatology were found to negatively influence health confidence, subjective well-being, and quality of life. Health confidence exerted a direct positive effect on psychological well-being. The negative impacts of psychological distress on well-being were mediated by health confidence. Additionally, health confidence and well-being were found to have an overall positive effect on quality of life. Conclusions: The findings suggest that health confidence is not merely a measure of self-care but also serves as a mediator of psychological distress and a significant factor related to well-being and quality of life among university students. Consequently, university authorities and public health agencies should prioritize the development and implementation of effective health confidence orientation and training programs for university students.