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

Background 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. More and more Chinese students have been troubled by psychological symptoms (PS). The relationship between SHS and PS is unclear in adolescents. This study aimed to investigate the prevalence of SHS and PS in Chinese adolescents and the relationship between SHS and PS and to identify the risk factors of SHS from the perspective of public health. Methods 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. Results 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 <0.01). The scores for various dimensions of SHS among the depression and anxiety groups were higher compared to those of the non-depression and non-anxiety groups (all P <0.01 ). Multivariate regression showed that compared with sleeping less than six hours, 6–8 hours is a protective factor for SHS ( OR  = 0.486, 95% CI  = 0.278–0.851). Conclusions Attention should be paid to the SHS and PS of Chinese middle school students and there is a strong association between SHS and PS among them. Lack of sleep is a risk factor for SHS so that sufficient sleeping time should be highly recommended as an advised measure to prevent SHS. Further discovering the risk factors of SHS and ensuring adequate sleep will benefit the health status of adolescents.