Mental Health Markers and Protective Factors in Students with Symptoms of Physical Pain across WEIRD and non-WEIRD Samples – a Network Analysis

Abstract More than 20% of youths experience a mental health disorder by the end of adolescence and 45% of the global burden of disease lies in the youth age range (18–25 years). These issues have now increased due to the stress of the COVID-19 pandemic especially among students. In addition to mental health issues, physical pain has become a major health problem among youth in general and university students in particular, with around 54% of them suffering from it each year worldwide. While research in non-Western, Educated, Industrialized, Rich, and Democratic (WEIRD) samples is less frequent, we recently reported a 45% prevalence of physical pain among university students in India. Prior studies conducted in Western societies identified that specific factors, i.e., posttraumatic stress disorder (PTSD), depression, anxiety, perceived stress, as well as protective factors like social support and self-efficacy have been associated with physical pain. Few studies have examined these factors across different cultures. Our study aimed to understand the relationship between specific mental health markers (i.e., depression, anxiety, PTSD, perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students and the possible differences and similarities across non-WEIRD and WEIRD samples in the interaction using network analysis which allows us to go beyond the traditional approaches and help us to understand which mental health marker might be particularly central to the experience of physical pain. No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Interestingly, anxiety came to be the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain. Also, these symptoms (and associations between symptoms) found in our study can contribute to the existing literature and keep in mind the existing cultural differences in the area of pain. Also, our study can be prioritized in theoretical models of physical pain and might also serve as important treatment targets for pain interventions among students before it becomes chronic in the future for both countries.