Examining the interplay between mental health indicators and quality of life measures among first-year law students: a cross-sectional study

Stress, anxiety and depression-interconnected mental health challenges

The interplay between stress, anxiety, and depression is intricate, with each condition potentially aggravating the others, highlighting the need for a holistic approach to mental health care (Ridley et al., 2020). Overall, mental health encompasses various aspects of quality of life (Snoek et al., 2018). These include the ability to engage in meaningful activities, maintain satisfying social relationships, and foster a positive body image. Regular physical activity, for instance, has been linked to numerous mental health benefits, including reduced stress and improved mood (Levine, Tabri & Milyavskaya, 2023). Similarly, a balance between work, leisure, and personal responsibilities contributes to life satisfaction and psychological well-being (Saraswati & Lie, 2020). Social relationships also play a critical role; strong social support networks can buffer against stress, reduce feelings of loneliness, and promote resilience, while social isolation can exacerbate symptoms of anxiety and depression (Bond et al., 2007; Janke, 2020). Furthermore, body image, or one’s perception of their physical appearance, can significantly influence mental health, with negative body image potentially leading to low self-esteem and even eating disorders (Xu & Liu, 2020).

Prior studies examining mental health of law students

Mental health is not a singular concept but rather a complex amalgamation of emotional, psychological, social, and physical factors (Sutherland, 2023; Cipu & Dragnea, 2007). The mental health of law students has been the subject of considerable research, revealing a concerning prevalence of psychological distress in this population. Skead, Rogers & Johnson (2020) emphasized the role of place, people, and perception in law student well-being, highlighting how the physical and social environments, along with individual perceptions of law school, significantly affect mental health outcomes. The pressures unique to legal education, such as the Socratic method and high-stakes exams, have been linked to increased levels of anxiety and depression among law students (Organ, Jaffe & Bender, 2016; Quintanilla & Erman, 2020; Mitchell, 2024). Moreover, research by Sheldon & Krieger (2007) and Ryan & Deci (2020) demonstrated that law students often experience a decline in well-being over the course of their studies, attributed to a shift in motivation from intrinsic to extrinsic factors. This transition can lead to a diminished sense of autonomy and competence, exacerbating feelings of stress and contributing to mental health issues. Similarly, studies have found that law students report higher rates of substance use, sleep disturbances, and suicidal ideationcompared to their peers in other academic disciplines (Dammeyer & Nunez, 1999; Pritchard & McIntosh, 2003; Krill, Johnson & Albert, 2016; DeBlasis & Usman, 2017).

This body of literature underscores the critical need for interventions tailored specifically to law students, addressing the unique stressors they face and promoting resilience and well-being within this group. By situating the present research within this context, it becomes clear how it contributes to the broader understanding of law student mental health, particularly in its focus on the relationships between mental health indicators (depression, stress, and anxiety) and various measures of quality of life (affective valence, mood states, physical activity, body image, and social relations).

Given the high levels of psychological distress documented among law students in prior studies, this research aims to investigate the intricate relationships between mental health indicators and various aspects of quality of life among first-year law students. By analyzing correlations and potential predictive factors, the research seeks to identify key influences on mental health within this population. The ultimate goal is to provide evidence-based insights that can inform the development of tailored interventions to enhance the well-being of law students.

Research objectives

To explore the feasibility of predicting mental health outcomes, such as depression, stress, and anxiety, based on key independent variables, within the context of a small sample size of 75 first-year law students. Recognizing the limitations that this sample size imposes on the generalizability of the results, the study currently applies regression analysis to identify significant predictors, including mood states, physical activity, body image perception, and social relations quality. The primary aim is to evaluate the strength and significance of these predictors within the cohort, providing initial insights that may guide future research with larger and more diverse samples. Although the findings may have limited applicability, they offer valuable information on the most influential factors affecting mental health in this specific population.

To explore the potential for predicting mental health outcomes based on key independent variables. Although the study is limited by the sample size of 75 first-year law students, this objective aims to use regression analysis to investigate how factors like mood states, physical activity, body image perception, and social relations quality may predict levels of depression, stress, and anxiety within this cohort. The goal is to identify significant predictors that could inform mental health interventions, recognizing that broader, more diverse samples are needed for more generalizable conclusions.

To discuss the practical implications of the associations identified between mental health indicators and quality of life factors in the context of developing targeted interventions for law students. This involves a thorough exploration of how relationships between depression, stress, anxiety, and factors such as mood states, physical activity, body image, and social relations can be effectively translated into actionable strategies aimed at enhancing the mental health and well-being of law students. This objective focuses on interpreting the findings to understand how the relationships between mental health indicators and quality of life factors can guide the development of targeted mental health interventions. The discussion will emphasize the potential strategies for improving the overall well-being of law students and suggest directions for future research.

Study design

The study was an observational, descriptive, experimental, and cross-sectional design, conducted between April 17 and June 2, 2023 (Indu & Vidhukumar, 2019), focusing on quantitative measures.

The first stage entails participant recruitment, selection, and signing of participation agreement, between April 17 and April 24, 2023. Participants were recruited from four university Physical Education and Sports classes without any incentives. We adopted a convenience sampling approach, considering the participants were university students, assuming they had more free time (Simkus, 2022). This contributed to reducing variations in assessing the effects of physical activity on mental health, which is important to ensure that the results are more consistent and reliable. By minimizing differences in time availability and daily routines, we could better isolate the impact of physical activity on mental health outcomes, leading to clearer and more accurate conclusions.

In the second stage, initial assessment, occurring between April 25 and April 29, 2023, participants completed six comprehensive questionnaires: WHOQOL-BREF, CDRS, MBPAQ, EIFI, FS, and DASS-21, covering various domains including quality of life, depression, physical activity, anxiety, and stress levels.

In the third stage, data centralization from initial assessments, between April 28 and April 29, 2023, the collected information was centralized into a database, applying quality control measures to verify data accuracy and ensure confidentiality.

In the fourth stage, analysis of initial data, between April 30 and May 30, 2023, we used SPSS version 23, including descriptive statistics, Person correlation “r,” and regression analysis highlighting unstandardized coefficients-B.

Participant selection-inclusion and exclusion criteria

Participants for the study were selected based on specific inclusion and exclusion criteria to ensure the validity and relevance of the research outcomes.

Inclusion criteria:

• 1)

  Age-participants were required to be between 19 and 30 years old.

• 2)

  Student status–only individuals currently enrolled as first-year law students were eligible for the study.

These criteria were established to focus the study on a population likely to exhibit similar lifestyle patterns, which is crucial for assessing the effects of physical activity on mental health.

Exclusion criteria:

• 1)

  Severe medical or psychological conditions-individuals with significant health issues that could impact mental or physical health were excluded to avoid confounding variables.

• 2)

  Use of psychoactive medications-participants taking medications that could alter mood or behavior were not included, as these could interfere with the study’s assessments.

• 3)

  Previous participation in similar programs-those who had already participated in similar physical activity programs were excluded to prevent bias from prior experience or learned responses.

• 4)

  Medical contraindications for physical exercise-individuals with medical conditions that contraindicate physical activity were excluded to ensure participant safety.

• 5)

  Non-participation in a maximum of two sessions-to maintain consistency and accuracy in the data collected, participants were required to attend at least all but two of the scheduled sessions.

• 6)

  Lack of written consent-only those who provided informed, written consent were included in the study, ensuring ethical standards were met.

Subjects

A total of 75 first-year law students (46 females and 29 males) from the Faculty of Law and Social Sciences at the 1 Decembrie 1918 University of Alba Iulia participated in this study. Initially, 120 students were invited to join the study, of which 85 expressed interest in participating. These students were recruited through their Physical Education and Sports classes, a mandatory part of their university curriculum, with no incentives offered for participation. However, after screening, 10 students were excluded: five exceeded the age limit, two had a history of cardiac surgery, two were diagnosed with asthma, and one was excluded due to locomotor impairments. This selection process resulted in a final sample size of 75 participants.

Table 1 provides an overview of the participants, who have an average age of 21.03 years, indicating that the group primarily consists of young adults with minimal age variation. The majority of the sample is female, with women making up 61.33% of the participants. All participants share a common educational background, having completed high school.

Socioeconomically, the group is characterized by a significant proportion (54.67%) working for minimum wage, while the remaining 45.33% have no income, suggesting that most participants fall within lower-income brackets. In terms of living arrangements, 42.67% of the participants live with their parents, 34.67% reside in student dormitories, and 22.67% rent their own accommodations.

Regarding physical activity, the group is nearly evenly split: 54.67% engage in low levels of physical activity, while 45.33% report slightly above-average levels. Geographically, the majority of participants (64%) are from urban areas, with the remaining 36% coming from rural regions. This group is composed of predominantly female, young adults with limited financial means, who live in various housing situations, mostly within urban environments, and generally report low levels of physical activity.

Research tools

This study utilized six validated instruments commonly employed in academic settings to assess various psychological and physical health dimensions among students.

Data analysis

We conducted various statistical analyses to explore and interpret the relationships between the study variables and their impact on mental health indicators. The following methods were employed:

Descriptive statistics

Table 2 presents the descriptive statistics for various items, including depression, stress, anxiety, affective valence (FS), mood states (EIFI), total physical activity assessment (MBPAQ), actual mood states assessment (CDRS), and social relations evaluation (WHOD3). Mean values indicate the average score for each item, while SD (Standard Deviation) represents the variability or spread of scores around the mean.

Correlation analysis between mental health variables and quality of life measures

Table 3 illustrates the correlations between mental health variables and other measures of quality of life, including affective valence (FS), mood states (EIFI), physical activity assessment (MBPAQ), body image (CDRS), and social relations evaluation (WHOD3). The table displays Pearson correlation coefficients for each pair of variables and their significance levels (Sig2). The correlations are based on data from a sample size of 75 participants. Significance levels are indicated by asterisks, with ** denoting significance at the 0.01 level and * denoting significance at the 0.05 level, both two-tailed.

Prediction of depression, stress and anxiety levels based on relevant independent variables

Table 4 presents the results of multiple regression analyses predicting stress, anxiety, and depression levels based on various independent variables. The table includes both unstandardized coefficients (B) and standardized coefficients (Beta) for each predictor, along with their corresponding significance levels (p-value). The independent variables analyzed are depression, anxiety, mood states (EIFI), physical activity assessment (MBPAQ), body image (CDRS), and social relations evaluation (WHOD3). These results shed light on the predictive relationships between mental health indicators and these factors.

• 1)

  Depression:

  • – Stress and anxiety are significant predictors of depression, with standardized coefficients (Beta) of 0.708 and 0.779, respectively. This indicates that anxiety has a slightly stronger impact on depression compared to stress.

  • – Physical activity (MBPAQ) and social relations (WHOD3) are also significant negative predictors of depression, suggesting that higher levels of physical activity and better social relationships are associated with lower levels of depression.

• 2)

  Stress:

  • – Anxiety is the strongest predictor of stress (β = 0.805), followed by depression (β = 0.738). This highlights a strong interconnection between these mental health indicators.

  • – Social relations (WHOD3) negatively predict stress levels, suggesting that better social relationships reduce stress.

  • – Interestingly, physical activity (MBPAQ) also negatively predicts stress, indicating its beneficial role in stress reduction.

• 3)

  Anxiety:

  • – Depression is the most significant predictor of anxiety (β = 0.752), followed by stress (β = 0.682).

  • – Social relations (WHOD3) and physical activity (MBPAQ) negatively predict anxiety, highlighting their importance in managing anxiety levels.

  • – Body image (CDRS) and mood states (EIFI) are also significant positive predictors of anxiety, albeit with smaller effects.

The regression analyses underscore the intertwined nature of stress, anxiety, and depression among the study participants, with significant contributions from physical activity, social relations, and body image. The strong predictive relationships highlight the importance of these factors in mental health interventions. This analysis also emphasizes the need to address multiple facets of well-being in developing holistic approaches to mental health care for law students.

Descriptive statistics and correlation analysis

The descriptive statistics from our study reveal that the levels of depression (mean = 5.97), stress (mean = 7.81), and anxiety (mean = 6.17) among first-year law students are notably high. These figures align with previous research highlighting elevated mental health challenges in law students compared to their peers in other academic disciplines. For example, Skead & Rogers (2015) reported increased psychological distress among law students due to the demanding nature of legal education, a finding that is corroborated by our data. Similarly, the study by Rabkow et al. (2020) reported significant mental health issues among German law students, with anxiety and depression being particularly prevalent. Our analysis also indicates that physical activity is significantly correlated with lower levels of depression, stress, and anxiety. This finding is consistent with previous studies, such as those by Skead & Rogers (2016) and Skead, Rogers & Johnson (2020), which demonstrate the protective effects of physical activity on mental health. Regular exercise appears to mitigate some of the psychological burdens experienced by law students, reinforcing the broader literature that supports physical activity as a crucial component of mental well-being.

The role of social relations and body image perception emerged as significant factors in our study. We found that positive social interactions are associated with lower levels of stress and anxiety, consistent with the research of Baba & Bunji (2023), who emphasized the importance of social support. Similarly, poor body image perception was linked to higher levels of anxiety, aligning with findings from Skead, Rogers & Doraisamy (2018). These results underline the importance of addressing both social and self-perception factors in mental health interventions.

Mood states and affective valence also showed significant correlations with mental health indicators in our study. These findings resonate with Ayres et al. (2017), who highlighted the impact of emotional regulation on managing anxiety among law students. The correlation between mood states and mental health outcomes suggests that improving emotional well-being could play a critical role in alleviating mental health issues. This study confirms existing research on the significant mental health challenges faced by law students, emphasizing the critical roles of physical activity, social relations, and self-perception. Our findings uniquely highlight how these factors are interrelated and collectively influence mental health outcomes. The strong correlations observed suggest that interventions enhancing physical activity, social support, and self-perception could effectively improve mental health among law students. To address these challenges comprehensively, a holistic approach is essential. Future research should explore these correlations further in varied contexts and larger, more diverse populations to deepen our understanding and validate these findings.

Prediction of mental health levels

Our regression analyses revealed that anxiety and stress are strong predictors of depression among law students. This finding is in line with Mukta et al. (2022), who demonstrated that negative emotional states significantly impact overall well-being and academic performance. The interdependence of these mental health indicators in our study suggests that effective interventions should address anxiety and stress as primary targets to reduce depression levels. Physical activity was identified as a significant predictor of lower levels of depression, stress, and anxiety. This supports the findings of Skead & Rogers (2016) and Şahin, Çekin & Yazıcılar Özçelik (2018), which highlight the mental health benefits of regular exercise. Our study extends these findings by confirming that physical activity is a crucial element of mental health strategies, especially in high-pressure environments like law school.

The negative association between social relations and mental health problems found in our study underscores the importance of fostering strong social connections. This aligns with Baba & Bunji (2023), who noted that social support is crucial for managing stress and anxiety. Our results suggest that interventions designed to enhance social ties could be effective in improving mental health among law students. Additionally, body image perception and mood states were significant predictors of anxiety. This finding is consistent with Skead, Rogers & Doraisamy (2018), who found that body image concerns and mood dysregulation contribute to psychological distress. Our results indicate that addressing body image and mood management could be effective strategies for reducing anxiety levels, particularly in competitive academic environments.

Moreover, the predictive relationships identified in our study highlight the intertwined nature of stress, anxiety, and depression. This interconnection is well-documented in the literature; for example, Hjorth et al. (2016) found that mental health issues are strongly correlated with academic challenges and higher dropout rates. The overlap between these mental health indicators suggests that interventions should not only target individual symptoms but also address the underlying factors that contribute to overall psychological distress. Overall, the predictive relationships identified in our study highlight the interconnected nature of mental health indicators. The overlap between anxiety, stress, and depression suggests that a comprehensive approach addressing multiple factors is necessary for effective mental health interventions. The findings support the need for holistic strategies that encompass physical activity, social support, body image improvement, and emotional regulation.

Our study supports and expands upon existing research by identifying anxiety, stress, physical activity, social relations, and body image as key predictors of mental health outcomes among law students. The strong predictive relationships observed highlight the need for a holistic approach to mental health care that addresses various aspects of students’ lives to foster overall well-being. This underscores the necessity for comprehensive strategies that target these areas simultaneously. To build on these insights, future research should explore these predictors in diverse contexts and larger populations, enhancing our understanding and guiding the development of tailored interventions for law students and other high-stress groups.