Introduction

Suicide, deliberate self-harm and the negative aspects of mental health and well-being have previously been the primary focus of much research. Studies from around the world focusing on the mental health and well-being of third level students have investigated risky behaviours and poor mental health and well-being [1–6]. Much of this research has highlighted alcohol and drug abuse, financial pressures and academic concerns [1,2] as determinants of mental health and well-being. However, a dearth of information on positive mental health and well-being among this population has been identified.

Historically, humankind has always been fascinated with the determinants of human health, happiness and well-being [7]. Positive mental health can be defined as “the scientific study of those positive strengths and virtues that enable people & communities to reach optimal levels of health, happiness and well-being” [8]. This adopts the view that positive mental health and well-being is a positive concept which goes beyond healthy lifestyles to overall well-being and replaces the traditional medical perspective which has mainly focused on the treatment of mental illness [9]. As highlighted by Seligman, positive mental health and well-being is grounded in the philosophy of positive psychology [8,10] and health promotion [11].

Recently, the Warwick Edinburgh Mental Well-Being Scale (WEMWBS) was developed as a measurement of positive mental health and well-being. In 2007, a report on its validity, variability and social desirability among a general and student population was published [12]. However, the determinants of positive mental health and well-being have yet to be investigated among a third level student population utilising WEMWBS. Thus, the aim of this research is to investigate the distribution and determinants of positive mental health and well-being in a large, broadly representative sample of Irish third level students.

Materials and Methods

Results

Baseline characteristics of the student sample are presented by gender in Table 1. Faculty, year in college and accommodation differed significantly by gender (p<0.05). As expected, women were more likely to be taking Health and Welfare undergraduate degrees. Over 40% of the sample were in first year. Gender distribution varied slightly by college year with a higher proportion of women in second year. Men were less likely to be living in campus accommodation (8.93% vs. 14.9%) and more men reported living at home with their parents than women (47.74% vs. 39.2%).

No statistically significant differences were observed between men and women in relation to age, physical activity, alcohol consumption or smoking. Over 40% of students reported moderate levels of physical activity, while in excess of 65% of students reported hazardous alcohol consumption. Over a quarter of students reported having smoked 100 cigarettes in their lives. Men were significantly more likely to report six or more sexual partners compared to women (22.5% vs. 13.6%; p<0.001). In addition, men were more likely to report taking at least one form of illicit drug use during the previous 12 months (40.4% vs. 26.4%; p<0.001).

WEMWBS scores were normally distributed in this population (Figure 1). Mean WEMWBS scores were slightly higher in men than in women (p=0.015). Distributions of men and women’s WEMWBS scores, categorised as below average, average and above average mental well-being, are displayed in Table 1.

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Figure 1. Distribution curve for WEMWBS scores among a third level student population

https://doi.org/10.1371/journal.pone.0074921.g001

Analysis of variance was undertaken to investigate whether significant differences in WEMWBS scores were evident among different socio-demographic, social and lifestyle factors reported by students. Analysis was conducted separately for men and women (Table 2).

Among men, mean WEMWBS scores were similar in relation to age group, area of study, accommodation, smoking status, drug use, BMI and number of sexual partners. Mean WEMWBS scores differed significantly by year of study, alcohol use and physical activity. Third year students reported higher average WEMWBS scores than their first year (52.36 vs. 49.91; p=0.012), second year (52.36 vs. 49.39; p=0.012) and fourth year (52.36 vs. 50.2; p=0.012) counterparts. Mean WEMWBS scores were higher among hazardous alcohol consumers versus non-hazardous consumers (51.07 vs. 48.65: p<0.001). Evidence of a non-linear relationship between physical activity and mental health and well-being was recorded. Men reporting moderate physical activity have significantly lower WEMWBS scores than men reporting low levels of physical activity (49.37 vs. 51.53; p=0.013)

Among women, mean WEMWBS scores differed by age with those aged 22 and older reporting better mental health and well-being than their female counterparts aged 20. However, there was no difference in WEMWBS scores for lifestyle or socio-demographic characteristics among women.

Discussion

This is one of the first studies to examine mental health and well-being scores in a broad, largely representative sample of third level students and the first to report on the factors associated with positive mental health and well-being using WEMWBS. The findings from this study suggest that students with a relatively adverse health and lifestyle profile have higher than average mental health and well-being. Significant, but relatively small differences in mental health and well-being scores were observed between men and women. However, no association between alcohol consumption, obesity, drug use or smoking status and positive mental health and well-being were detected in this research.

As highlighted by Cranford et al, the effect of alcohol use on mental health and well-being is unclear [15]. The current research did not uncover an association between alcohol use and positive mental health and well-being adding to the conflicting results of previous research. The Harvard college alcohol study found that poor mental health was associated with an increased risk of alcohol use. However, other research has reported positive associations between mental health and alcohol abuse with one study indicating “that associations between mental disorders and alcohol involvement among college students emerged only for alcohol dependence” [15].

When Needham et al investigated the effect of weight status on mental health and well-being among adolescents, the association between weight and mental health was context specific. Young girls and adolescents in lower grades experienced being overweight more negatively. Needham concludes that the rising rates of obesity among adolescents may act as a buffer to the stigma associated with being overweight and obese in this population [16]. This study found no association between BMI status and mental health and well-being in either men or women. This may be due to rates of overweight and obesity continuing to rise in Ireland. As more individuals become overweight stigma reduces, impacting less on the individuals mental health and well-being.

Research investigating the effect of smoking on mental health and well-being were more unified with strong associations between nicotine dependence and mood and anxiety disorders being evidenced [15]. In 2004, Patterson et al conducted a review of current research in the area concluding that symptoms of anxiety and depression are associated with cigarette smoking among American college students [17]. However, the current research is at odds with pre-existing knowledge in the area. No association between cigarette smoking and mental health and well-being in the current study was observed. Smoking habits are regularly underreported [18], an issue which may be skewing the results of this study.

Previous research investigating the effect of recreational drug use on mental health and well-being has provided conflicting results. In 2009, Cranford et al reviewed the literature surrounding mental health and well-being and recreational drug use [15]. This review provided differing results as to the relationship between recreational drug use and mental health and well-being. Some research reported a positive association between drug use and mental health and anxiety while others report a negative effect [15,19]. This study finds that recreational drug use is not associated with mental health and well-being among a third level student population.

Low levels of physical activity and one or more sexual partners in a lifetime were all associated with positive mental health and well-being in the current research. In 2005, Penedo undertook a review investigating the benefits of physical activity. This review identified a reduction in anxiety and depression among college students who completed physical activity [20]. Specifically, physical activity was associated with improved mood and a reduction in the symptoms of depression or anxiety. Several research studies have solidified this result [21–25]. This is, however, at odds with the current research where low levels of physical activity are associated with increased positive mental health and well-being among men. Levels of physical activity reported among our student population were relatively high, measured using the International Physical Activity Questionnaire (IPAQ). Despite the fact that the IPAQ has been extensively validated and recommended as an effective method of assessing physical activity participation [26], there are some limitations associated with its use. According to Saelens and Sallis (2003) one of the main limitations associated with IPAQ arises due to the fact that self-reported measures can often result in the over estimation of physical activity participation [27]. In fact, it has been suggested that the IPAQ may over estimate physical activity participation to a greater extent than other physical activity surveys [28,29]. Another limitation of the IPAQ is that survey participants can often experience difficulties distinguishing between moderate and vigorous intensity activities [30], a factor which can also result in the over estimation of physical activity. It is possible that these limitations affected the findings in our study.

In 2006, Martens et al reported on the differences between actual and perceived student norms in relation to sexual behaviour. Martens discovered that “students overestimated the sexual activity of the typical student” [31]. Sexual health is regularly viewed as a risk factor but is also a positive aspect of life. Some studies have reported high numbers of sexual partners as a normative occurrence among the third level student population [32,33]. Although risky behaviour, adherence to contraception and protection against sexually transmitted diseases should be of concern in this group, students may feel happier as they align themselves to the perceived sexual norms of their peers. Our finding of multiple lifetime sexual partners being associated with higher than average mental health supports this view.

Conclusion

The findings of this study are somewhat unusual in that students with an adverse lifestyle pattern have a higher than average mental health and well-being. Students represent a unique subgroup that is relatively privileged when compared to the general population [35]. Findings from this study may not be applicable to the general population. Previous research suggests that hazardous alcohol consumption and a high number of lifetime partners are social norms in this culture, meaning those closer aligned with the norms for their culture may report more positive mental health and well-being. This is evidenced in the current study. There is a need to replicate this research yielding a higher response rate to confirm the factors associated with positive mental health and well-being among third level students. A study of the general population is also warranted.