Suicide literacy in The Gambia.

Globally, approximately 235 million students are enrolled in tertiary education, a figure projected to exceed 600 million by 2040 as higher education access expands across developing regions []. This rapid expansion has elevated student health as a public health priority. Large-scale surveys document a substantial mental health burden in this population: the WHO World Mental Health International College Student (WMH-ICS) project, conducted across 19 countries and over 14,000 students, estimated that 20.3% of college students met 12-month criteria for a common mental disorder []. More recent surveys following the COVID-19 pandemic report substantially higher rates, with pooled prevalence of depression and anxiety exceeding 30–40% in multi-country samples [, ]. The long-term consequences extend beyond wellbeing: psychological distress in college students is associated with academic underperformance, reduced workforce readiness, and increased risk of chronic mental illness in adulthood [, ]. Among the health complaints reported by college students, fatigue is both highly prevalent and insufficiently studied as an independent endpoint. Physiologically, fatigue encompasses progressive reduction in the capacity to sustain effort as well as persistently diminished energy at rest []. In young adults without serious medical illness, fatigue most commonly presents as a central syndrome. It is characterized by cognitive slowing, motivational loss, and emotional exhaustion. This presentation is distinct from the peripheral muscular fatigue of athletes and from cancer-related fatigue in oncology [, ]. As a transdiagnostic symptom spanning depressive, anxiety, and functional somatic presentations, fatigue may precede diagnosable mental disorders and function as a sensitive early-warning signal [, ]. Despite its relevance, fatigue appears to have been less frequently examined as a standalone primary outcome in college student research, compared with depression and anxiety. Within this global landscape, China presents a particularly salient context. With over 47.6 million students enrolled in higher education in 2023, China operates the world’s largest tertiary education system []. The academic environment is highly competitive. Pressure begins with the gaokao college entrance examination and continues through postgraduate preparation and employment competition []. These structural demands may amplify fatigue burden beyond what is observed in lower-pressure educational settings. Studies conducted during and after the COVID-19 pandemic document elevated rates of psychological distress among Chinese college students [, ], yet population-level data on fatigue specifically, including its prevalence, severity distribution, and modifiable determinants, remain limited. Most prior Chinese studies focused on single institutions, specific disciplines, or the pandemic period [].