The influencing factors of depression among Chinese male nursing students: application of decision tree and FsQCA

BMC Nurs. 2025 Jul 8;24(1):877. doi: 10.1186/s12912-025-03407-z.

ABSTRACT

OBJECTIVE: Although a few studies have explored the mechanism of depression in male nursing students using traditional methods, new methods such as decision tree and fuzzy-set qualitative analysis (fsQCA) are worth introducing to further explore the mechanism of depression.

METHODS: A cross-sectional study was conducted to investigate the depression status of 466 male nursing students in mainland China. Both decision tree and fsQCA models were constructed to discover and compare their results regarding conditions configuration.

RESULTS: The trained decision tree demonstrated acceptable predictive performance (AUC = 0.78). The feature importance ranking placed self-esteem first, followed by childhood adversity, perfectionism, perceived stress, and insomnia. No necessary condition was identified in fsQCA. The sufficient conditions analysis discovered four conditions configuration in depression and non-depression group, respectively. Specifically, perceived stress was a shared factor in all conditions configuration for depression group while self-esteem for non-depression group. Moreover, the two models found the same configuration causing depression, which is a combination of low self-esteem, childhood adversity history, high perfectionism, and high perceived stress.

CONCLUSIONS: This study identified the combination of low self-esteem, childhood adversity history, high perfectionism, and high perceived stress as a key pathway to depression in male nursing students. Perceived stress was central to depression, while self-esteem effectively protected male nursing students from depression. Interventions should target these modifiable factors for nursing educators.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:40629301 | DOI:10.1186/s12912-025-03407-z