Mental health among university students: The associations of effort-reward imbalance and overcommitment with psychological distress

Background: Mental health problems are highly prevalent among university students, but little is known about their underlying determinants. This study explores mental health among university students, the association between “effort-reward imbalance” (ERI), overcommitment and mental health, and to what extent ERI and overcommitment explain gender differences in mental health. Methods: Cross-sectional data were analyzed from 4760 Italian university students. The Kessler Psychological Distress Scale-10 was used to measure self-reported psychological distress, as an indicator of mental health, and the ERI – Student Questionnaire to measure effort, reward and overcommitment. The associations between ERI and overcommitment with psychological distress were estimated with multinomial logistic regression analyses. Results: 78.5% of the respondents experienced psychological distress, with 21.3%, 21.1%, and 36.1% reporting respectively mild, moderate and severe psychological distress. Female students were more likely to report moderate and severe psychological distress. ERI and overcommitment were strongly associated with severe psychological distress with ORs respectively up to 19.9 (95% CI: 12.2–32.5) and 22.2 (95% CI: 16.1–30.7). ERI and overcommitment explained part of the higher odds of severe psychological distress among female students comparing to males, attenuating the ORs from 2.3 (95% CI: 1.9–2.7) to 1.4 (95% CI: 1.2–1.7). Limitations: This cross-sectional study was performed on a large, but convenient sample. Discussion: More than one out of three students reported severe psychological distress. Decreasing ERI and overcommitment may be beneficial in the prevention of psychological distress among university students and may reduce gender differences in psychological distress. Longitudinal studies are needed to further investigate these associations.