General health, anxiety, and depression: relationship with perceived self-efficacy and positive mental health in nursing students

Bandeira, Eliel de Oliveira; Pompeo, Daniele Alcalá; Sasaki, Natália Sperli Geraldes Marin dos Santos; Pancote, Camila Garcel; Menezes-Júnior, Luiz Antônio Alves de; Alves, Danilo de Miranda; Eid, Letícia Palota; Lourenção, Luciano Garcia

doi:10.1590/1980-220X-REEUSP-2025-0260en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 59 • 2025 • https://doi.org/10.1590/1980-220X-REEUSP-2025-0260en linkcopy

General health, anxiety, and depression: relationship with perceived self-efficacy and positive mental health in nursing students^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To analyze the general health, anxiety, and depression of nursing students and analyze their relationship with the perception of general self-efficacy and positive mental health while coping with COVID-19.

Method: A cross-sectional, descriptive, and correlational study with 138 nursing students from a public institution. Instruments were applied for sociodemographic variables, the Hospital Anxiety and Depression Scale, the General Self-Efficacy Scale, the General Health Questionnaire, and the Positive Mental Health Questionnaire. The analyses included descriptive statistics, correlations, and univariate and multivariate logistic regression.

Results: A 5% increase in the Positive Mental Health score was associated with a 20.4% reduction in the probability of anxiety (OR = 0.83; 95% CI: 0.73–0.93) and a 26.6% reduction in the probability of depression (OR = 0.79; 95% CI: 0.70–0.89). Similar increases in the General Health Questionnaire were associated with higher probabilities of anxiety (29%) and depression (18%). A 5% increase in the perception of general self-efficacy reduced the probability of both outcomes (anxiety and depression) by 12.4%.

Conclusion: Positive mental health and self-efficacy were protective factors, reinforcing the importance of institutional actions to promote academic well-being.

DESCRIPTORS
Students, Nursing; Mental Health; Self Efficacy; Anxiety; Depression

Variables	Anxiety n (%)	p-value	Depression n (%)	p-value
Race
White	83 (87.4)	0.114	47 (92.2)	0.047
Non white	12 (12.6)	0.114	4 (7.8)	0.047
Living status
Living alone	12 (12.6)	0.020	7 (13.7)	0.134
Living with family	65 (68.4)		30 (5.8)
Living with friends	18 (19.0)		14 (27.5)
Feel happy and fulfilled with undergraduate degree
No	10 (10.5)	0.509	9 (17.7)	0.011
Yes	85 (89.5)	0.509	42 (82.3)	0.011
Feeling overloaded by undergraduate activities
No	3 (3.2)	<0.001	2 (3.9)	0.045
Yes	92 (96.8)	<0.001	49 (96.1)	0.045
Performs paid work
No	74 (77.9)	0.264	36 (70.6)	0.026
Yes	21 (22.1)	0.264	15 (29.4)	0.026
Feels frequently stressed
No	4 (4.2)	<0.001	1 (2.0)	0.002
Yes	91 (95.8)	<0.001	50 (98.0)	0.002
Family relationships
Harmonious	75 (78.9)	0.040	37 (72.6)	0.009
Conflicting	20 (21.1)	0.040	14 (27.5)	0.009
Engages in leisure activities weekly
No	38 (40.0)	0.001	27 (52.9)	<0.001
Yes	57 (60.0)	0.001	24 (47.1)	<0.001
Psychological or psychiatric counseling
No	58 (61.1)	0.008	29 (56.9)	0.030
Yes	37 (38.9)	0.008	22 (43.1)	0.030
Have you ever hurt yourself on purpose to relieve suffering?
No	62 (65.3)	0.001	34 (66.7)	0.138
Yes. during my undergraduate studies	14 (14.7)		5 (9.8)
Yes. before my undergraduate studies	19 (20.0)		12 (23.5)
Had suicidal thoughts
No	44 (46.3)	<0.001	23 (45.1)	0.017
Yes. during my undergraduate studies	28 (29.5)		16 (31.4)
Yes. before my undergraduate studies	23 (24.2)		12 (23.5)

	Anxiety score	Depression score	SMP total	QSG12 score	Self-efficacy score
Anxiety score	–	r: +0.703 p < 0.001	r: –0.216 p = 0.011	r: +0.743 p < 0.001	r: –0.520 p < 0.001
Depression score	r: +0.703 p < 0.001	–	r: –0.185 p = 0.030	r: +0.723 p < 0.001	r: –0.630 p < 0.001
SMP total	r: –0.216 p = 0.011	r: –0.185 p = 0.030	–	r: –0.172 p = 0.440	r: +0.166 p = 0.520
QSG12 score	r: +0.743 p < 0.001	r: +0.723 p < 0.001	r: –0.172 p = 0.440	–	r: –0.619 p < 0.001
Self-efficacy score	r: –0.520 p < 0.001	r: –0.630 p < 0.001	r: +0.166 p = 0.520	r: –0.619 p < 0.001	–

	Anxiety		Depression
	Univariate	Multivariate1	Univariate	Multivariate2
SMP total
Increase 5%	0.86 (0.78–0.94)	0.83 (0.73–0.93)	0.82 (0.75–0.91)	0.79 (0.70–0.89)
Increase 10%	0.73 (0.61–0.89)	0.68 (0.54–0.87)	0.68 (0.56–0.82)	0.62 (0.49–0.80)
QSG12 score
Increase 5%	1.27 (1.17–1.38)	1.29 (1.18–1.42)	1.19 (1.12–1.27)	1.18 (1.11–1.26)
Increase 10%	1.62 (1.38–1.90)	1.67 (1.39–2.01)	1.42 (1.26–1.61)	1.39 (1.22–1.59)
Self-efficacy score
Increase 5%	0.92 (0.88–0.95)	0.89 (0.84–0.95)	0.89 (0.85–0.93)	0.89 (0.85–0.94)
Increase 10%	0.83 (0.78–0.90)	0.80 (0.71–0.90)	0.79 (0.73–0.86)	0.79 (0.72–0.88)

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[1] Spearman correlation test.

General health, anxiety, and depression: relationship with perceived self-efficacy and positive mental health in nursing students*

ABSTRACT

General health, anxiety, and depression: relationship with perceived self-efficacy and positive mental health in nursing students^*