Psychosocial and lifestyle factors associated with premenstrual syndrome symptoms among Chinese female college students: a cross-sectional study

BMC Nursing https://doi.org/10.1186/s12912-026-04765-y Article in Press Psychosocial and lifestyle factors associated with premenstrual syndrome symptoms among Chinese female college students: a crosssectional study Lixin Zeng, Xiuying Guo, Chai Nien Foo & Myo Oo Received: 24 February 2026 Accepted: 11 May 2026 Cite this article as: Zeng L., Guo X., Foo C.N. et al. Psychosocial and lifestyle factors associated with premenstrual syndrome symptoms among Chinese female college students: a cross-sectional study. BMC Nurs (2026). https://doi.org/10.1186/ s12912-026-04765-y A S S We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply. IN E R P If this paper is publishing under a Transparent Peer Review model then Peer Review reports will publish with the final article. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. ACCEPTED ARTICLEMANUSCRIPT IN PRESS Psychosocial and lifestyle factors associated with premenstrual syndrome symptoms among Chinese female college students: A cross-sectional study Lixin Zeng1,2, Xiuying Guo2, Chai Nien Foo3,*, Myo Oo3,* 1 M Kandiah Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sungai Long Campus, Kajang, Malaysia 2 International College of Nursing, Hainan Vocational University of Science and Technology, Haikou, China 3 S S E Department of Population Medicine, M. Kandiah Faculty of Medicine and Health PR Sciences, Universiti Tunku Abdul Rahman, Bandar Sungai Long, 43000 Kajang, Selangor, Malaysia E L C IN I T AR *Corresponding author: Myo Oo, ; Chai Nien Foo, Abstract Background: Premenstrual syndrome (PMS) refers to a range of physical and emotional symptoms occurring during the luteal phase of the menstrual cycle. It is closely linked to hormonal fluctuations, menstrual physiology, and lifestyle factors, and can significantly affect quality of life. This study aimed to investigate the prevalence of premenstrual syndrome symptoms and its associations with perceived stress, physical activity, and dietary quality among college students at a university in Hainan, China. 26 ACCEPTED ARTICLEMANUSCRIPT IN PRESS Methods: A self-administered, structured questionnaire was used to collect data on demographic, menstrual characteristics, stress, physical activity and dietary quality. Self-reported PMS symptoms were assessed using the Chinese version of the Premenstrual Syndrome Scale (PMSS). Perceived stress was measured using the 10item Perceived Stress Scale (PSS). Dietary quality was evaluated by calculating the Chinese Healthy Eating Index (CHEI) from a food frequency questionnaire. Physical activity levels were assessed with the short form of the International Physical Activity Questionnaire (IPAQ-SF). Data were analyzed using SPSS 26.0, with chi-square and Mann–Whitney U tests for group comparisons, and linear regression to assess factors associated with PMS symptoms score. Results: The prevalence of self-reported PMS symptoms among college students was 32.9%. In the multivariate analysis, PSS score was positively associated with PMS S S E symptoms score (B = 0.378, p < 0.001). Moderate-intensity physical activity (MPA) was negatively associated with PMS symptoms score (B = -0.087, p = 0.037). Among PR the components of the CHEI, higher red meat score (indicating lower intake) was IN significantly associated with lower PMS symptoms score (B = -0.436, p = 0.007). E L C Conclusion: The findings highlight psychosocial and lifestyle factors as important I T AR correlates of PMS symptoms and provide preliminary evidence to inform nursing screening and health promotion initiatives in campus health services. Longitudinal studies are needed to further explore these associations. Keywords: premenstrual syndrome; perceived stress; lifestyle modification; female college students Introduction Premenstrual syndrome (PMS) is a recurring condition affecting 30–40% of women of reproductive age. More than 200 symptoms have been attributed to PMS[1]. The most common symptoms include emotional instability, fatigue, appetite changes, and physical discomforts such as bloating, breast tenderness, and headache [2]. These 2 ACCEPTED ARTICLEMANUSCRIPT IN PRESS symptoms typically commence shortly after ovulation, gradually intensify, reaching a peak approximately 5 days before the onset of menstruation, and gradually subside by the end of menstruation[3]. Due to limited understanding of the mechanisms underlying PMS, the precise etiology of these disorders remains unclear and effective treatments are limited. Leading hypotheses focus on hormonal fluctuations, neurotransmitter abnormalities involving gamma-aminobutyric acid (GABA) and serotonin, and post-ovulation nutritional deficiencies such as vitamin B6, magnesium, and calcium [4], as well as the presumed role of circulating gonadal steroids in symptom development[5, 6]. Although widely studied, the exact cause of PMS is still unclear. Current drug treatments mainly manage symptoms rather than the root issue, with some women avoiding these options due to side effects or health concerns[7]. High-carbohydrate intake during the luteal phase may elevate serotonin levels, S S E potentially intensifying mood-related symptoms and explaining premenstrual PR carbohydrate cravings [8]. Additionally, nutrient deficiencies (such as B-group vitamins, vitamin D, and magnesium) and glucose metabolism abnormalities, along IN with unhealthy dietary patterns (e.g., high intake of calorie-dense, high-fat, high- E L C sugar, and high-salt foods) and lifestyle factors (e.g., smoking and lack of regular I T AR exercise), may significantly exacerbate PMS symptoms[3, 9–12]. Dózsa-Juhász et al. found that the severity of PMS symptoms is significantly influenced by re (...truncated)