Prevalence, symptom phenotype, and multidomain associated factors of fatigue among Chinese college students: a nationwide cross-sectional study

BACKGROUND: Fatigue is a highly prevalent but understudied health complaint among college students. This nationwide study aimed to estimate the prevalence, severity distribution, and lifestyle determinants of fatigue among Chinese college students using a validated multidimensional instrument. METHODS: A geographically stratified cross-sectional survey was conducted across 30 Chinese provinces. Full-time college students completed an anonymous online questionnaire including the Brief Fatigue Inventory (BFI), sociodemographic characteristics, lifestyle behaviors, and self-reported disease history. Hierarchical multiple linear regression was used to identify independent predictors of BFI Total Score. RESULTS: A total of 3,014 valid responses were analyzed (63.9% female). The overall mean BFI Total Score was 4.06 ± 2.01. Using established cutoffs, 49.0% experienced clinically meaningful fatigue (moderate or severe). The most prevalent co-occurring symptoms were difficulty concentrating (60.3%) and low mood (56.6%), indicating a predominantly cognitive-affective fatigue phenotype. Sleep duration was the strongest modifiable lifestyle predictor; sleeping fewer than 5 h per night was associated with a BFI increase of 0.90 points relative to the 7-8 h reference (β = 0.90, p < 0.001). Breakfast skipping (β = 0.20, p = 0.008) and late-night eating (β = 0.51, p < 0.001) were also significant independent predictors after full adjustment. A history of anxiety disorder was the single strongest predictor overall (β = 1.22, p < 0.001). The full model explained 13.3% of the variance in BFI Total Score (R²=0.133). CONCLUSION: Clinically meaningful fatigue affects nearly half of Chinese college students and presents a predominantly cognitive-affective phenotype. Anxiety disorder history and sleep deprivation are the leading determinants. Integrating psychological screening into fatigue consultations and implementing institutional sleep-protective policies are evidence-based priorities for campus health systems.