Psychological problems, including depression and anxiety, are complex and influenced by multiple factors. Depression is the third leading cause of illness and disability, affecting individuals of all ages. Its cumulative prevalence is low in childhood, increases sharply during adolescence, and peaks at approximately 20 % in early adulthood (Herrman et al., 2022), particularly among college students. Moreover, a systematic review of studies concluded that anxiety prevalence was 27.3 % (95 % CI: 23.7–31.2 %) (Pashazadeh Kan et al., 2021), underlining the persistently high incidence and urging measures for improving prevention and treatment strategies to avert unpredictable adverse consequences. The harm caused by depression and anxiety is not only high incidence, but also deadly damage to people. Recognizing depressive and anxiety symptoms is crucial for identifying individuals at risk of developing clinical depression and anxiety. Depressive and anxiety symptoms as an intermediate state, a better understanding of it can also help achieve a breakthrough in the prevention and treatment of depression and anxiety, a central focus in the field of mental illness. However, owing to the lack of reliable methods to accurately assess and predict a wide range of psychological problems, including technical and current subjective factors, progress has been hindered, considering that some remaining biological mechanisms are poorly understood. Most public health researchers have concluded that the causes of anxiety and depression symptoms are complex, including sociological factors such as humanistic factors and family and school environment factors, but that these factors do not fully explain the rapid development of mental health problems in modern society. They have suggested that other factors may also play a crucial role and that these factors may interact with each other. Given the relatively early onset of mental illness (Patton et al., 2014), understanding the factors associated with adolescent mental illness is critical to identifying potentially modifiable risk factors, to provide interventions (Bélair et al., 2018) that reduce the future incidence and burden of depression and anxiety. Therefore, it is necessary to determine the factors influencing mental health, and the theory of multi-factor interaction provides a basis for this premise. We attempt to provide some theoretical or model-based explanations for the causes of psychological problems, observe their correlation with psychological problems through biological indicators, and further determine the impact of their interaction on psychological problems.

Some studies suggest that cumulative risk models can help understand how psychosocial and environmental factors affect long-term outcomes. Among them, the social ecosystem model of public health (Bronfenbrenner, 1979), the cumulative ecological transaction risk perspective (Mackenzie et al., 2011), and socioecological psychology (Oishi, 2014) suggest that various socio-ecological risk factors (SERFs), including individual, family, school, community, and cultural factors, affect adolescents’ mental health. Risk and protective factors at different levels of influence (e.g., family, school, and peer levels) are directly or indirectly associated with psychological, emotional, and behavioral problems (Malcolm et al., 2013). Although the current study found an association, SERFs did not include the temporal dimension, which is also important for the influence of adolescent psycho-behavioral problems. We propose SERFs as a conceptual construct based on the well-known social-ecological model that includes individual, family, school, community, policy, and culture models. Since the social-ecological model cannot be measured, we quantify this model to intuitively measure adolescents’ social environment based on the social-ecological model. SERFs extend this basis. Our research group divided SERFs along the scales of spatial dimensions, such as individuals, families, schools, communities, policies and cultures, and the chronosystem, to quantitatively measure the social-ecological model—specifically, the performance of adolescents under the social-ecological model.

Empirical studies on a social support buffering model found that sufficient social support can cushion the impact of stressful events on adverse results, adjust emotional and behavioral changes, transform negative emotions into positive ones, and reduce the occurrence of severe outcomes. Social support stands as an important influencing variable correlating adverse experiences with mental health (Wiss et al., 2022), as well as serving as a form of resilience (Powell et al., 2021; Dudek et al., 2021). In this study, we focus on resilience as a variable and recommend that research on emerging psychopathologies focus on the factors influencing risk and resilience (Mesman et al., 2021). With the rise and continuous development of positive psychology, researchers have begun to explore mental health from a new perspective, emphasizing the development and utilization of individual potential, such as through resilience. Resilience refers to the interaction of protective factors, such as traits, abilities, and social resources possessed by an individual, with external pressures or crises, enabling individuals in adversity to establish a positive response (Feldman et al., 2020; Ungar et al., 2013). Psychological resilience theory is based on the study of disadvantaged children, which has overturned pessimistic conclusions of researchers about the development of children in high-risk environments.

Moreover, according to the State of Science Symposium, the role of resilience is further emphasized by extending metabolic pathways to aging diseases and functions (Smith et al., 2021). The relationship between resilience and mental health is theorized as follows: “resilience refers to the ability of an individual to cope successfully and adapt to and coordinate in the face of adversity, which has an important impact on children's social adaptation and psychological development” (Mesman et al., 2021; Ungar M and Theron L, 2020). The relationship between resilience and cardiovascular disease (CVD)/health (CVH) is theorized as follows: "Resilience may affect cardiovascular health through several potential mechanisms." Resilience may indirectly have a protective effect on CVD through behavioral pathways that positively influence health, such as physical activity (Gallo et al., 2004). In addition, the reserve capacity model hypothesizes that resilience - such as social support - mediates the impact of adversity on CVH by reducing physiological stress responses and promoting adaptive coping, thereby further promoting positive cardiovascular outcomes (Gallo, de Los Monteros, et al., 2009; Gallo & Matthews, 2003). Although different studies define the concept of resilience somewhat differently, the overall trend is to define resilience as positive outcomes or the absence of negative outcomes following adversity (Feldman et al., 2020; Ungar et al., 2013). Hence, resilience is likely to be the primary goal of improving CVH interventions (Park et al., 2022).

Many factors at multiple levels of social ecology theory (SET) may influence the processes leading to these differences, thus serving as a theoretical framework to explain the role of resilience (Cao, 2021) and suggesting that resilience and SERFs interact with each other. SET focuses on the ecosystem of individual growth, emphasizing the development and adaptation of individuals to macro-, meso‑, and microsystems (Mesman et al., 2021). SET theory, which encompasses the individual, family, school, community, and culture, clarifies issues from micro, meso, and macro perspectives. All these aspects can directly or indirectly influence individual behavior and health. The greater the exposure adolescents have to these factors, the more likely they are to experience adverse psychological and behavioral problems. Based on this theory, we previously proposed that factors affecting psychological problems also interact in different environmental contexts (Zhang et al., 2023). Moreover, Cabanis et al. (2021) constructed the overall living environment of adolescents through adverse childhood experience variables according to SET theory, explored its role in adolescent mental health problems, and found a positive correlation between the two (Cabanis et al., 2021). Moreover, SET theory can serve as both a risk factor and a protective factor. We can develop mental health prevention and treatment measures based on SET, which mainly includes interventions at the family level and the social level (e.g., schools and communities). More factors than we currently know influence the mechanisms that promote positive development in individuals exposed to atypically high levels of stress or adversity that predict mental disorders (Ungar and Theron, 2020).

The effects of biological factors are as follows. Severe mental illness is associated with a wide range of cardiovascular and metabolic behaviors (Goldfarb et al., 2022), and lipid metabolism and Alzheimer's disease appear to be in balance. Further, lipid metabolism can serve as a biomarker to predict future psychiatric disorders (Su et al., 2021). Patients with CVD have a higher incidence of depression than the general population. Most studies have focused on the association between depression and CVD; however, the association between CVH and depression in healthy people lacks adequate discussion. CVH is influenced by traditional risk factors and the possible contribution of metabolic syndromes to the global risk of CVD. It primarily consists of metrics such as obesity, blood glucose, high-density lipoprotein (HDL), triglyceride (TG), and blood pressure, and CVH reflects human cardiovascular metabolism to some extent. The correlation between cardiovascular metabolism and mental health has been reported; in one study, the prevalence of increased CVH was 15.2 % and 14.6 % in men and women, respectively (Tian et al., 2020). In the present study, we examined the variables associated with CVH and psychological problems.

Moreover, stress experienced by adults is an important disease trigger in individuals with already high atherosclerotic plaque buildup and can determine prognosis and outcome in individuals with pre-existing cardiovascular and cerebrovascular diseases (Kivimäki and Steptoe, 2018). Moreover, studies of animal models and patient lesions have explored the neural circuits and intermediate physiological pathways that link stress experiences with cardiovascular changes, in which central autonomic and physiologically controlled cortical, limbic, and brain stem regional networks may play a role in stress-related CVD risk (Ginty et al., 2017). Animal studies have demonstrated the effects of short-term fructose overfeeding and changes in the intrinsic regulatory mechanisms of resilience in the context of excess fructose intake, suggesting that efforts to maintain resilience may be a promising target in preventing and treating metabolic disorder-like diseases (Li et al., 2019). However, no such studies have been conducted on CVH or SERFs.

Similar situations exist, and this relationship further shapes the influence of other factors. McGue and Bouchard (1984) note that gender strongly influences most psychological variables. The distribution of psychological problems between men and women is not difficult to understand; hormonal reasons, coupled with environmental differences, naturally lead to different psychological problems. Literature shows that the role of gender in adjustment is stable, but it is more theoretical, with relatively few empirical results proposed. This study also explored differences in gender influences on psychological problems. Similar to SERFs, negative life events are also thought to play an important role in exacerbating mental health problems and triggering stress response mechanisms through the link between adverse experiences and depression (Sheerin et al., 2018), while the protective advantage of resilience is reversed. Moreover, although the close correlation between depression and adverse experiences has been well-documented in a large sample of college students worldwide (Kalmakis et al., 2020), research on the mediating role of SERFs in the relationship between CVH and depression in Chinese young people is limited, and the mediating role of resilience has not been reported.

Effective screening for emotional and behavioral problems, timely and effective preventive measures, and clear identification of vulnerable individuals are essential for promptly delivering early interventions, providing appropriate follow-up care, and reducing the risk of severe mental and chronic disorders. The mechanism by which sociopsychological environment-derived SERFs affect mental health remains unclear. Studies have shown a correlation between inflammation, metabolic metrics, and depression (Karageorgiou et al., 2023; Perry et al., 2022). Chronic stress is a major environmental risk factor for mental health, and stress levels in college students caused by SERFs tend to be higher at the beginning of college life. However, not everyone who is influenced by SERFs will have psychological problems, highlighting the need to identify biological determinants of stress vulnerability and resilience.

Currently, there are no clinically useful biological diagnostic markers or screening tests available to effectively predict the occurrence of depressive and anxiety symptoms, especially in conjunction with socioenvironmental factors. Adolescence is a critical stage for the onset of mental health problems. This study aims to closely examine the contributing factors of negative emotions and abnormal behaviors among college students and enhance their mental well-being by conducting annual physical examinations and screenings during the high-incidence period of mental health issues among this adolescent group. Upon reviewing the literature, we found cardiometabolic dysfunction to be prevalent among young people with psychosis (Perry et al., 2022). To better evaluate the correlation between CVH and anxiety and depression symptoms, we incorporated SERFs as the moderating variable because various factors affect college students’ living environment, and SERFs could evaluate their living environment in many ways. Resilience was selected as the mediating variable because it can serve as a bridge leading to psychological problems. Although the correlation between cardiovascular factors and psychological problems has been established, resilience can better mediate this relationship. Timely and effective intervention and treatment measures should be implemented to reduce the severity of emotional disorders and behavioral problems in adolescents, promote their mental health recovery, and provide a strong basis for decision-makers to formulate guidelines related to the prevention of mental health problems in adolescents or to establish expert consensus.

The aforementioned studies confirm the moderating role of SERFs in the relationship between metabolic metrics and mental health. Therefore, this study sought to (1) examine the interaction correlations between metabolic metrics, resilience, SERFs, and mental health and (2) investigate the moderating effect of SERFs and the mediating effect of resilience on the relationship between metabolic metrics and mental health among Chinese college students.