Mixed exposure to PFAS and OPEs is associated with increased depressive and anxiety symptoms in college freshmen

Objective: To examine individual and mixture associations of PFAS and OPEs with depressive and anxiety symptoms among college freshmen. Methods: This cross-sectional study included 1,247 Chinese freshmen with serum PFAS/OPE measurements and SDS/SAS scores. Associations were estimated using multiple linear regression, WQS regression, and BKMR, adjusting for demographic and lifestyle covariates. Results: In adjusted WQS models, each one-quartile increase in the mixture index was associated with higher depression (β=1.42; 95% CI, 0.28-2.56) and anxiety scores (β=1.96; 95% CI, 0.77-3.15). BKMR showed positive but imprecise mixture trends and identified PFHpA as a relatively important contributor. Conclusions: PFAS/OPE co-exposure was associated with greater depressive and anxiety symptoms, supporting mixture-based assessment of environmental mental health risks.