Discussion
AA has long been a hot topic in young adults. At the stage of physical and mental maturity, teenagers are delicate and sensitive, and they begin to care about their appearance, but external pressure on their appearance leads to negative emotions. Liao’s research shows that 78.8% of medical students in China are concerned about their appearance. It shows that the problem of AA is very serious among medical students, and high AA can lead to social anxiety and depression. Medical students’ focus on weight and figures may be related to AA ( Liao et al., 2010 ). This study is the first to explore the effects of IS and SS on adolescents’ AA and depression in a sample of 724 at Chongqing Medical University in Chongqing, China, and to investigate the effects of SS and IS as mediating variables on AA and depression mechanisms. The results of this study will contribute to the early detection and timely intervention of depression among medical college students and contribute to the healthy physical and mental growth of medical college students studying in medical schools. Moreover, this research can also make up for the research gap in this area at home and abroad in recent years, to have a certain impact on the prevention of mental illness of college students. AA scores vary by grade and BMI, which is possible because contemporary society promotes the concept of “thinness” as beauty ( Liao et al., 2010 ). It leads students to pay a lot of attention to their BMI, but further research is needed on the impact of grade level. As mentioned in previous articles, the increasing of age is likely to lead to increased levels of AA ( Carrard et al., 2021 ). IS varies by grade, home address, and grades. Freshmen may be at higher risk of IS because they have just entered a new environment and are mentally less mature than older students ( Xu et al., 2022 ). SS varies by gender, grade, BMI, only a child, home address, monthly income, ranking of results, single and discretionary income, and depression by grade and test score. Especially students who are undergoing graduate exams in their senior year are more likely to suffer from depression ( Chen et al., 2022 ).

This study found that AA positively and significantly predicted the onset of depression in a medical college student population, which is consistent with the findings of a study exploring the relationship between appearance and psychological distress ( Mirza et al., 2021 ). It is undeniable that appearance is the most intuitive “first face” in human interaction. People can use make-up to strengthen their confidence in their appearances, but it is more important to establish the correct concept of appearance and lessen the chance of AA. Previous studies have found that if they are more sensitive and attentive to their appearance than others, they may take a higher risk of depression ( Mirza et al., 2021 ). Depression is the leading cause of illness and disability among adolescents ( Ward et al., 2021 ). It is not that individuals will never have negative emotions such as depression and anxiety without mental problems at present. Actually, mental health can change. Especially, for example, in the early days of the exam, the number of students with depressive symptoms increases. This is possibly due to excessive psychological stress and challenges. Facing the exam, they have less time to unwind and thus psychological problems are exacerbated ( Chen et al., 2022 ). Therefore, more attention should be attached to the mental health of medical students, especially at the examination stage. The right amount of recreational activities and time with their families should be provided to students at this stage to increase SS and reduce their depression. When depression occurs during adolescence, they have a higher rate of recurrence of depression in the future and their quality of life will be seriously affected, which will increase the economic and health burden of society ( Petersen et al., 2022 ; Clayborne, Varin & Colman, 2019 ). In this regard, the corresponding relevant departments (especially schools) should attach high importance to the occurrence of depression among college students, conduct early mental health screening in a timely manner, provide additional psychological support to students at risk, and combine early detection with effective intervention in order to reduce the probability of college students suffering from depression and aggravation of the condition ( Mofatteh, 2021 ). At the same time, actively guiding students to reduce their external evaluations of others, building a good communication platform, and improving their coping and interpersonal skills can enable students to receive more campus support.

This study shows that IS not only is a mental health problem for medical college students but also it has a great potential to affect depression in college students with appearance anxiety. Medical college students with high IS are overly concerned about the feelings and behaviors of others and fear negative evaluations and rejections from others, therefore they are psychologically fragile and sensitive. Such students are at high risk of losing themselves and becoming depressed in order to avoid rejection and criticism. Previous studies have confirmed that people with IS traits are more likely to develop depression ( Boyce & Parker, 1989 ). In this regard, group counseling has been widely used in intervention studies of interpersonal communication and prevention of depression among college students with good results, and previous studies have also confirmed that group sand tray game therapy can effectively reduce IS of college students ( Young et al., 2016 ; Wen et al., 2011 ). Schools and other relevant departments can learn from the existing studies and actively carry out activities such as group counseling and group sand tray games to help individuals reduce IS and the occurrence of depression among college students.

This study confirmed the validity of hypothesis 3. SS is an important resilient resource for individuals in social life and a protective factor for college students’ physical and mental health ( Gecková et al., 2003 ). The result of this study indicating that higher SS can maintain a good emotional experience for individuals, enhance the coping and handle ability of college students when facing AA, and reduce the anxiety and depression caused by appearance ( Maulik, Eaton & Bradshaw, 2011 ). Specifically, SS was negatively correlated with AA, IS, and depression. A decrease in SS can seriously affect people’s psychological state, leading to increased levels of anxiety and depression. As a previous study shows, people with higher IS have lower SS, so people with higher SS are better able to face and adapt to relationships ( Montag et al., 2020 ). Family and friends should give more love and accompany to youth who are in sensitive periods, encourage and support them when they suffer setbacks, and give them timely help when they encounter difficulties. State authorities should also give high priority to the occurrence and treatment of depression among college students, and help youth receive reliable support and the benefits they deserve. and build a good platform to improve their coping ability and interpersonal skills.

Findings in this study enriched the mediating influences of AA leading to depression: college students with AA faced with higher SS or lower IS would reduce the occurrence of depression. Also, the results found that IS was significantly and negatively correlated with SS (r = −0.319, P < 0.01), meaning that among college students with AA, those with lower IS received more SS and thus reduced the incidence of depression. College students, especially medical school students, are the backbone of social construction and development in the future. Although youth is often considered to be the best stage of health, this is by no means a reason to neglect the physical and mental health of college students. All departments should take active measures to attach great importance to the physical and mental health of college students studying in a medical school and draw a blueprint for a healthy and happy future together.

Although all the hypotheses in the study are valid, the limitations of the study must also be acknowledged. Firstly, it is a cross-sectional research method and the causal relationship among AA, IS, SS, and depression is unclear. So the longitudinal studies could be conducted based on this study to further explore the causal relationships between variables. Secondly, the study was conducted about 3 months after the strict prevention and control of COVID-19 had been lifted in China, and because of the wearing of masks, people’s anxiety about their appearance may change, which is unknown. Another survey of AA can be conducted several years later and compared it with this study to get conclusions. Thirdly, the population of this study were students of Chongqing Medical University, and due to the special nature of their specialties, they will have a more scientific perception of physiological appearance than other college students. If the findings of this study are to be extended to other specialties or schools, the representative sample needs to be further expanded to reduce the error. In addition, unfortunately, we did not further exclude people with previous or current major psychological problems in our study, which may bias our findings.