Abstract
BACKGROUND: College students are increasingly experiencing psychological distress, which adversely affects their academic performance, social functioning, and overall quality of life. While many studies have investigated the prevalence and correlates of psychological symptoms in this population, fewer have explored how psychological symptoms and their co-occurrence relate to self-reported mental health service needs. METHODS: We conducted a cross-sectional study involving 22,624 college students to explore the complex relationships between various psychological symptoms and their implications for self-reported mental health service needs. Standardized assessments, such as the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), Insomnia Severity Index (ISI), and Impact of Event Scale (IES-R), were utilized to evaluate psychological symptoms. A self-developed questionnaire was used to gather data on mental health service requirements. Mediation analysis was used to explore the reciprocal mediation effects between different psychological symptoms on the self-reported mental health service needs. Network analysis was employed to explore the interrelationships between psychopathological symptoms and their impact on self-reported mental health service needs. RESULTS: Overall, 2.2% of all respondents and 5.0% of those with at least one psychological symptom reported mental health needs. Self-reported mental health needs differed among individuals with different psychological symptoms and comorbidity. Individuals with anxiety alone exhibited a higher self-reported mental health service needs compared to individuals with depression alone, insomnia alone, and PTSD alone. Unlike other comorbid conditions, anxiety comorbid with other symptoms does not significantly increase their self-reported mental health needs. Reciprocal mediation effects were observed between psychological symptoms and self-reported mental health service needs. Anxiety symptoms showed the strongest mediation effects, accounting for 42.7% of the total needs for depression symptoms, 42.2% for insomnia symptoms, and 44.6% for PTSD symptoms. Network analysis revealed that PHQ-9 item related to suicidal ideation (item 9) had the strongest correlation with self-reported mental health needs, with psychological hotline services and self-learning psychological knowledge being the preferred service types. CONCLUSION: The self-reported mental health needs of college students are closely linked to their psychological symptoms and comorbidities, with anxiety playing a key mediating role in driving service demands. Universities should implement stratified interventions by prioritizing early anxiety screening and management, providing urgent support for suicidal thoughts, and reallocating resources toward symptom-specific care.