Suboptimal health among Chinese middle school students may be associated with psychological symptoms and sleep duration: a cross-sectional survey in China

Suboptimal health status (SHS) is an intermediate status between ideal heath and illness, it is characterized by the perception of health complaints, general weakness, decreased immunity and low energy. An increasing number of Chinese middle school students are suffering from psychological symptoms (PS), particularly anxiety and depression. The relationship between SHS and PS is unclear in adolescents. This study aimed to investigate the prevalence of SHS and the correlation between SHS and PS among Chinese middle school students and to identify the SHS-related risk factors from the perspective of public health. A cross-sectional study was conducted with the cluster sampling method among 1955 middle school students in Shantou, China. SHS was assessed by Suboptimal Health Status Questionnaire-25 (SHSQ-25). And the PS of anxiety and depression were assessed with Generalized Anxiety Disorder Scale (GAD-7) and Beck Depression Inventory-II Scale (BDI-II) self-assessment questionnaires. Variate logistic analysis was applied to explore risk factors of SHS. The relationship between SHS and PS among Chinese middle school students was subsequently analyzed. Among the 1955 participants, 1904 middle school students were finally included in the analysis, the effective response rate was 97.39%. The prevalence of SHS was 10.3% (197/1904) while the prevalence of anxiety and depression was 30.7% (585/1904) and 34.1% (649/1904), respectively. A strong correlation was identified between SHS and PS among middle school students. With the aggravation of anxiety and depression, the probability of suffering from SHS increased (both P