What matters most for undergraduates' psychological well-being? A structural equation model analysis of modifiable behaviors in the ACHA-NCHA.

Objective: Identify the strongest predictors of undergraduates' well-being and evaluate how these factors interact. Participants: 79,246 undergraduates from the Spring 2024 American College Health Association-National College Health Assessment IIIb. Mean age was 21.7 ± 4.8; the sample included diverse gender and racial/ethnic identities. Methods: In this cross-sectional study, structural equation modeling (SEM) evaluated a latent well-being factor including flourishing, loneliness, psychological distress, and suicidality. Thirty predictors were identified through exploratory factor analysis and were modeled simultaneously to assess contributions and interactions. Results: Time spent socializing and engaging in work and family obligations were the strongest positive predictors of well-being. Interpersonal problems, substance use, insomnia, and screen time were strongly associated with worsened well-being. Trends were consistent between students with and without diagnosed anxiety or depression. Conclusions: Undergraduates' well-being reflects interacting social, behavioral, and environmental influences. Interventions should strengthen social connections, improve sleep, encourage healthier technology use, and reduce substance-related risks.