Impact of family functioning on mental health problems of college students in China during COVID-19 pandemic and moderating role of coping style: a longitudinal study.

BACKGROUND: During the COVID-19 pandemic, college students were required to stay at home and maintain social distance for the entire spring semester of 2020. There is little research on how family functioning influenced mental health problems and how coping styles moderated the relationship between family functioning and mental health problems among college students during their stay-at-home period. METHODS: A total of 13,462 college students (age = 16-29 years) completed four online surveys between February and October 2020, namely the outbreak phase, remission phase, online study phase, and school reopening phase in Guangdong Province, China. Family functioning was assessed by the Family APGAR; coping styles were assessed by the Simplified Coping Style Questionnaire (SCSQ), depression symptoms and anxiety symptoms were evaluated by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) respectively. Generalized estimating equations were used to assess associations between variables, the logit link function was used to estimate the odds ratio of different subgroups, the Newton-Raphson method was used to estimate parameters, and the Wald test was used to test the main effect and the interaction effect. RESULTS: The incidence rates of depression increased during the stay-at-home period from 33.87%, 95% CI (29.88%, 38.10%) to 40.08% 95% CI (35.76%, 44.55%) after schools reopened, χ2 = 193.68, p < 0.001. The incidence rates of anxiety increased from 17.45%, 95% CI (14.59%, 20.73%) to 26.53%, 95% CI (16.94%, 23.67%) over the entire period, χ2 = 195.74, p < 0.001. The percentages of students with highly functional, moderately dysfunctional and severely dysfunctional family functioning were 48.23%, 43.91 and 7.86% at T1 and 46.20%, 45.28%, and 8.52 at T4, respectively. The percentage of subjects with active coping style was 23.9%, negative coping style was 17.4%, strong response coping was 26.9%, and weak response coping was 31.7%. The incidence rate of depression and anxiety for different family functioning groups varied at different time points, and the interaction effect was significant (χ2 = 52.97, p < 0.001 and χ2 = 51.25, p < 0.001, respectively). The incidence rate of depression and anxiety for different family functioning groups with different coping styles also varied at different time points, the interaction effect was likewise significant (χ2 = 862.09, p < 0.001 and χ2 = 583.29, p < 0.001, respectively). CONCLUSIONS: Having a severely dysfunctional family and a negative coping style increase the incidence rates of depression and anxiety. These findings highlight the importance of paying special attention to college students' family functioning and promoting appropriate coping strategies during and after COVID-19.

An Unusual College Experience: 16-Month Trajectories of Depressive Symptoms and Anxiety among Chinese New Undergraduate Students of 2019 during the COVID-19 Pandemic.

BACKGROUND: This study examines the trajectories of the mental health conditions of 13,494 new undergraduate students who enrolled in 2019 in China from the beginning of the pandemic to the local recurrence of the pandemic, and found factors which may be associated with diverse trajectories. METHODS: The trajectories of depression-anxiety outcomes were modeled using the growth mixture model. The multinomial logistic regression model was used to identify variables associated with different trajectory groups. RESULTS: Both depression and anxiety in the new college students slightly increased during the 16-month period. The slopes of depression and anxiety were lower after the local outbreak. From the trajectories of depression and anxiety, five heterogeneous groups were identified: low-stable (64.3%), moderate-increased (18.2%), high-stable (11.1%), recovery (4.5%), and rapid-increased (1.8%). Environmental, somatic, and social factors were used to differentiate the low-stable group from the other groups. We found that college students with female gender, more conflict with parents, and feelings of loneliness during the pandemic were more likely to enter a high stability trajectory compared to a recovery trajectory. CONCLUSION: Most participants showed a stable mental health status, while others experienced deteriorating or chronic mental health problems, especially those who had sleep disturbances, less social support before the pandemic, or conflicts with parents during the pandemic. These students may need additional support and monitoring from college mental health providers to improve their wellbeing.

Intolerance of uncertainty and anxiety among college students during the re-emergence of COVID-19: Mediation effects of cognitive emotion regulation and moderation effects of family function.

OBJECTIVE: In June 2021, the COVID-19 spread again in the community, and residents had to face the impact of the outbreak again after 276 days, none of the local cases in Guangdong Province, China. The purpose of this study was to investigate the mechanisms underlying the relationship between intolerance of uncertainty (IU) and anxiety in college students in non-epidemic area during the periods of re-emergence of COVID-19. METHODS: A survey was conducted among 86,767 college students in Guangdong Province, China from 10 to 18 June 2021, information on the Intolerance of Uncertainty Scale (IUS), General Anxiety Disorder-7 (GAD-7), Cognitive Emotion Regulation Questionnaire (CERQ) and Family APGAR Index were collected. Five moderation and mediation models were analyzed using latent moderated structural equations. RESULTS: The results showed that IU was positively related to anxiety (r = 0.42, p < 0.000). After controlling for age and gender, latent moderated structural equations indicated that catastrophizing mediated the relationship between IU and anxiety, and family function acted as a moderator in this relationship. Further analyses indicated that IU directly affected anxiety and had indirect effects on anxiety by catastrophizing. This relationship was weaker among college students who reported lower family function. CONCLUSION: This study provides practical implications for designing intervention strategies to reduce anxiety in college students when the epidemic re-emerges.

Longitudinal changes in fear and anxiety among Chinese college students during the COVID-19 pandemic: a one-year follow-up study.

There is growing evidence that levels of fear and anxiety have increased during the COVID-19 pandemic. However, given regular epidemic prevention and control measures, longitudinal changes and causal factors in the incidence of fear and anxiety need to be measured and explored. College students completed online surveys in two wave studies a year apart. The participants who completed both of the surveys numbered 22,578. The online surveys were completed at the pandemic's normalization/prevention stage (T1, from June 1 to 15, 2020) and during a phase of new local transmission of the disease in Guangdong Province (T2, from June 10 to 18, 2021). Multiple linear regressions were used to examine fear and anxiety predictors from demographic characteristics. Fear related to COVID-19 had significantly decreased at T2 (t = 66.64, p < 0.001), however, anxiety had significantly increased at T2 (t = -5.03, p < 0.001). In particular, not implementing preventive measures (e.g., handwashing) during the COVID-19 pandemic had the greatest impact in predicting the change in fear levels. By contrast, prior poor mental health status contributed the most in predicting the change in degree of anxiety. These results suggest different changes in anxiety levels (deterioration) and degree of fear (mitigation) occurred as the COVID-19 pandemic progressed. These findings have implications for planning mental health crisis provisions and have long-term impact beyond this pandemic.

Prevalence and associated factors of suicidal ideation among college students during the COVID-19 pandemic in China: a 3-wave repeated survey.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic, a major public health crisis, harms individuals' mental health. This 3-wave repeated survey aimed to examine the prevalence and correlates of suicidal ideation at different stages of the COVID-19 pandemic in a large sample of college students in China. METHODS: Using a repeated cross-sectional survey design, we conducted 3 online surveys of college students during the COVID-19 pandemic at 22 universities in Guandong, China. The 3 surveys were conducted during the outbreak period (T1: 3 February to 10 February 2020, N = 164,101), remission period (T2: 24 March to 3 April 2020, N = 148,384), and normalized prevention and control period (T3: 1 June to 15 June 2020, N = 159,187). Suicidal ideation was measured by the ninth item of the Patient Health Questionnaire-9. A range of suicide-related factors was assessed, including sociodemographic characteristics, depression, anxiety, insomnia, pre-existing mental health problems, and COVID-19-related factors. RESULTS: The prevalence of suicidal ideation was 8.5%, 11.0% and 12.6% at T1, T2, and T3, respectively. Male sex (aOR: 1.35-1.44, Ps < 0.001), poor self-perceived mental health (aOR: 2.25-2.81, Ps < 0.001), mental diseases (aOR: 1.52-2.09, P < 0.001), prior psychological counseling (aOR: 1.23-1.37, Ps < 0.01), negative perception of the risk of the COVID-19 epidemic (aOR: 1.14-1.36, Ps < 0.001), depressive symptoms (aOR: 2.51-303, Ps < 0.001) and anxiety symptoms (aOR: 1.62-101.11, Ps < 0.001) were associated with an increased risk of suicidal ideation. CONCLUSION: Suicidal ideation appeared to increase during the COVID-19 pandemic remission period among college students in China. Multiple factors, especially mental health problems, are associated with suicidal ideation. Psychosocial interventions should be implemented during and after the COVID-19 pandemic to reduce suicide risk among college students.

Prevalence and associated factors of depression, anxiety and suicidality among Chinese high school E-learning students during the COVID-19 lockdown.

BACKGROUND: The outbreak of Coronavirus disease (COVID-19) in 2019 and the resulting quarantine may have increased the prevalence of mental health problems in adolescents. The aim of this study was to explore the association between the effects of home-based learning during the pandemic and the risks of depression, anxiety, and suicidality among junior and senior high school students. METHODS: An online survey using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) was conducted between 12 to 30 April 2020, on a total of 39,751 students. Multivariable logistic regression analysis was used to analyze the risk factors of associated depression, anxiety and suicidality during the pandemic. RESULTS: Prevalence of depression, anxiety symptoms and suicidality found was 16.3% (95% CI: 16.0, 16.7), 10.3% (95% CI: 10.0, 10.6) and 20.3% (95% CI: 19.9, 20.7), respectively. Participants with female gender and in junior high school, with poor overall sleep quality and poor academic performance and very worried about being infected during COVID-19 were highly associated with the risk of depression, anxiety symptoms and suicidal ideation (all P<0.001). CONCLUSIONS: Prevalence of self-reported mental health problems for adolescents using home-based distance learning was high. Implementing measures (e.g., wearing face masks) and spending only moderate time focusing on COVID-19-related information could be protective factors for mental health. These results provide suggestions for teachers and policy makers regarding adolescent improving sleep quality (sufficient sleep) and academic performance and reducing worry about pandemic during quarantine to prevent mental health problems.