Adherence to 24-hour movement guidelines and mental health outcomes in Chinese university students

BACKGROUND: Mental health problems such as depression, anxiety, and stress are highly prevalent among university students and may lead to long-term adverse outcomes. Emerging evidence suggests that 24-hour movement behaviors-including physical activity, sedentary behavior, and sleep-play an important role in psychological well-being. However, limited research has examined these behaviors collectively within the 24-hour movement framework among Chinese university students. METHODS: A cross-sectional survey was conducted among 836 full-time university students in 2025. Physical activity and sedentary behavior were assessed using the IPAQ-SF, and sleep duration was measured using items from the Pittsburgh Sleep Quality Index. Mental health was evaluated using the DASS-21. Compliance with the Canadian 24-Hour Movement Guidelines was categorized by the number and types of recommendations met. Multivariable linear and logistic regression models were used to examine associations between guideline adherence and psychological symptom scores and risks, adjusting for demographic covariates. RESULTS: Overall, 23 students met none of the guidelines, while 140, 379, and 294 met one, two, and all three guidelines, respectively. The prevalence of stress, anxiety, and depressive symptoms was 84.4%, 61.4%, and 78.0%. Compared with meeting none of the guidelines, meeting all three was associated with significantly lower prevalence of anxiety (OR = 0.41, 95% CI: 0.17-0.96) and depressive symptoms (OR = 0.21, 95% CI: 0.08-0.50). Meeting two guidelines were also related to lower odds of depressive symptom (OR = 0.32, 95% CI: 0.14-0.77). Among behavior combinations, strongest relationship was shown between meeting both PA, sedentary behavior and anxiety (OR = 0.33), depressive symptoms (OR = 0.28). CONCLUSIONS: Adherence to multiple 24-hour movement guidelines is strongly associated with better mental health outcomes among Chinese college students. These findings highlight the potential of integrated movement-based strategies in university mental health promotion.