Mental Health Risk Configuration Among Pre-service Practitioners in High Emotional Labor Service Industries: A Cross‑sectional Mixed‑methods Study on Sleep and Depression Risk

This study employed a mixed-method approach combining latent profile analysis and fuzzy-set qualitative comparative analysis to explore the complex relationship between multidimensional sleep patterns and depression risk among future high emotional labor professionals. A stratified cluster sampling survey was conducted among 4334 university students from relevant majors in two universities in Shandong and Hebei provinces. Latent profile analysis identified two main sleep profiles: a "healthy sleep profile" (87.2%) and a "problematic sleep profile" (12.8%), characterized by evening preference, insufficient sleep, and high social jetlag. Regression analysis indicated that the latter was independently associated with higher levels of both state and trait depression, with a particularly strong link to trait depression. Further fuzzy-set qualitative comparative analysis revealed differentiated pathways to depression: state depression functioned as a "final common pathway," triggered by various combinations of conditions centered on acute sleep insufficiency, while trait depression was associated with more specific pathways, primarily involving the sustained interaction between sleep insufficiency and chronic circadian stress (arising from either external social jetlag or internal circadian misalignment). Theoretically and mechanistically, this study supports the existence of "problematic sleep" as a synergistic risk syndrome and corroborates the heterogeneity theory of depression. At a practical level, the findings underscore the dual strategic significance of sleep health management for future high emotional labor professionals, serving both to protect occupational capacity and prevent psychological issues.