Worry and fear during the COVID-19 epidemic normalization: Analyzing prevalence and risk factors among 182,991 high school students in China.

It is worth paying attention to the level of worry and fear of students during the normalization of the epidemic. We conducted the cross-sectional study that included 182,991 high school students using an online survey to assess worry and fear levels and its influencing factors in three cities in Henan Province, China, from May 21 to May 27, 2021. Worry and fear levels were measured using a five-item Likert-type scale. Multinomial logistic regression was used to analyze the risk factors. Approximately 65.42% of students reported being high worry about the coronavirus disease 2019 (COVID-19) epidemic, and about 41.44% of students reported being high fear about the COVID-19 epidemic. In addition, compared with female, male had lower odds of suffering from a high worry, and compared with senior high school students, junior high school students were more likely to suffer from a high worry. Students lived in rural had highest odds increased likelihood of high worry. Similar results in fear levels. During the normalization period of the COVID-19 epidemic, many students have high levels of worry and fear. This study has implications for potential influencers of worry and fear levels in follow-up work.

Association between attitudes toward the COVID-19 vaccines and mental health among 140,259 college students in China.

Background: With the launch of the COVID-19 vaccines, the vaccination rate has become a hot issue of concern. However, the evidence for the relationship between college students' attitudes toward vaccines and anxiety and depressive symptoms has been limited. Methods: In total, 140,259 college students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, May 21-27, 2021. Anxiety symptoms were determined by the Generalized Anxiety Disorder tool (GAD-7) and depressive symptoms were determined by the Patient Health Questionnaire (PHQ-9). Multiple logistic regression was performed to estimate the association between students' attitudes toward the vaccines and anxiety and depressive symptoms. Results: The results indicate that 22.45% of students are unclear whether the vaccine can protect them from infection and 45.57% are unclear whether the vaccine is safe and has no side effects. In addition, after adjusting, the model showed that students who think vaccines can protect them and are safe had 0.128 (95%CI 0.110-0.150; Ptrend < 0.001) times lower risk of anxiety compared to their counterparts who think vaccines can neither protect them nor are safe. Similar ORs were found in depression (aOR = 0.157; 95%CI 0.137-0.180). Conclusion: This large-scale study has shown an association between symptoms of anxiety and depression and reluctance to obtain vaccination. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-023-01830-7.

The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort.

The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020-10 October 2020), Canada 2 and China (11 October 2020-16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77-5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.

Prevalence and risk factors of depressive symptoms among 140,259 college students during the COVID-19 epidemic normalization in China: A cross-sectional survey.

Objective: College students are one of the most vulnerable populations to the COVID-19 pandemic's mental health effects. During the coronavirus disease 2019 (COVID-19) outbreak, we wanted to see how common depressive symptoms were among college students and what factors contributed to that. Methods: Between 21 and 27 May 2021, 140,259 college students from three cities in Henan Province, China, were involved. The Patient Health Questionnaire-9 was used to determine depressive symptoms (PHQ-9). Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% CIs for potential depressive symptom factors. Results: Mild depressive symptoms and above are present in 21.12% of college students. Women had a higher prevalence of mild depressive symptoms than men (61.38 vs. 59.75%), and depressive symptoms were most prevalent among rural students and least prevalent among city students (21.44 vs. 20.29%). Participants with depressive symptoms are also more likely to have a poor-behavioral status. From none-to-severe depressive symptoms, 78.88, 15.78, 2.80, 1.67, and 0.88% had them. Gender, residential location, and behavioral status were found to be associated with depressive symptoms after adjusting for potential confounders. Conclusion: This cross-sectional study identified the factors that influence the prevalence of depression in college students. It found that the government should pay more attention to mental health issues affecting college students in combating the COVID-19 epidemic normalization.

Attitude toward COVID-19 vaccines and its association with depressive symptoms in 386,924 Chinese primary school students during COVID-19 epidemic normalization.

AIM: Before Chinese primary school students were generally vaccinated against the COVID-19 vaccine, this study evaluated the willingness of this population and its influencing factors before vaccination, and evaluate its association between attitudes toward the vaccine and depressive symptoms. METHODS: A cross-sectional study involved 386,924 primary school students using a cluster sampling method during May 21-27, 2021. The Chinese version of the Children Depression Inventory (CDI) was used to assess depressive symptoms. Multiple logistic regression analysis models were used to estimate the relationship between attitudes toward COVID-19 vaccines and depressive symptoms. RESULTS: Among the participants, the prevalence of depressive symptoms was higher in higher grades. The prevalence was higher in fifth and sixth grade students than third and fourth grade students and first and second grades (10.22% vs. 6.07% vs. 3.04%). In addition, 20.79% of students do not know whether the vaccine can protect him from the COVID-19 infection, and 40.60% of students do not know whether the vaccine is safe. Of note, in terms of attitudes toward COVID-19 vaccines, students with more positive attitudes have a lower risk of depressive symptoms (adjusted odds ratio (aOR) = 0.151; 95% confidence interval (CI): 0.140-0.164). CONCLUSION: Based on these findings, it is necessary for the government and schools to promote vaccine safety and reliability information in a timely manner to increase vaccination uptake.

Comparison of 19 major infectious diseases during COVID-19 epidemic and previous years in Zhejiang, implications for prevention measures.

BACKGROUND: The global pandemic of coronavirus disease 2019 (COVID-19) has attracted great public health efforts across the world. Few studies, however, have described the potential impact of these measures on other important infectious diseases. METHODS: The incidence of 19 major infectious diseases in Zhejiang Province was collected from the National Notifiable Infectious Disease Surveillance System from January 2017 to October 2020. The entire epidemic control phase was divided into three stages. The government deployed the first level response from 24 January to 2 March (the most rigorous measures). When the outbreak of COVID-19 was under control, the response level changed to the second level from 3 to 23 March, and then the third level response was implemented after 24 March. We compared the epidemiological characteristics of 19 major infectious diseases during different periods of the COVID-19 epidemic and previous years. RESULTS: A total of 1,814,881 cases of 19 infectious diseases were reported in Zhejiang from January 2017 to October 2020, resulting in an incidence rate of 8088.30 cases per 1,000,000 person-years. After the non-pharmaceutical intervention, the incidence of 19 infectious diseases dropped by 70.84%, from 9436.32 cases per 1,000,000 person-years to 2751.51 cases per 1,000,000 person-years, with the large decrease in the first response period of influenza. However, we observed that the daily incidence of severe fever with thrombocytopenia syndrome (SFTS) and leptospirosis increased slightly (from 1.11 cases per 1,000,000 person-years to 1.82 cases per 1,000,000 person-years for SFTS and 0.30 cases per 1,000,000 person-years to 1.24 cases per 1,000,000 person-years for leptospirosis). There was no significant difference in the distribution of epidemiological characteristic of most infectious diseases before and during the implementation of COVID-19 control measures. CONCLUSION: Our study summarizes the epidemiological characteristics of 19 infectious diseases and indicates that the rigorous control measures for COVID-19 are also effective for majority of infectious diseases.

Prevalence and Associated Factors for Elevated Depressive Symptoms in 386,924 Primary Students during the COVID-19 Pandemic Normalization in China.

We aimed to assess the prevalence of elevated depressive symptoms and its associated factors during the coronavirus disease 2019 (COVID-19) pandemic among primary students in China. We included 386,924 students aged 6-12 years from three cities in Henan province, China, over the period 21-27 May 2021. The overall prevalence of depressive symptoms was 5.8%. Participants with high depressive symptoms were more likely to be senior urban primary students, and exhibited an insignificant increase in hand washing frequency, non-mask wearing behavior, higher error rates of cognition tests, and greater levels of worry and fear. The associated factors for high depressive symptoms were found to include age, sex, grade, location, worry level, fear level, cognitive status, and change in lifestyle after gaining knowledge about COVID-19. Our results suggest that governments need to focus on factors affecting the mental health of school-age children while combating COVID-19, as it would facilitate better decision making on the international and national level.

Association between mask wearing and anxiety symptoms during the outbreak of COVID 19: A large survey among 386,432 junior and senior high school students in China.

AIM: To evaluate the association between mask wearing practice and the risk of anxiety symptoms during the COVID-19 epidemic among Chinese students aged 12-18 years old. METHODS: Totally, 386,432 junior and senior high school students were recruited using a cluster sampling method across three cities of Henan Province in China during February 4-12, 2020. Mask wearing practice was defined according to its type and the behavior exhibited in relation to wearing a mask. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the association between mask wearing and anxiety symptoms. RESULTS: Among the participants, compared with students who completely adhered to the all the mask wearing practice, students who did not adhere to all the mask wearing practice had 1.97 times more likely to suffer from anxiety symptoms (adjusted odds ratio (aOR) = 1.97; 95% confidence interval (CI): 1.74-2.22). Furthermore, compared with students who did not know the proper type of mask, students who knew the proper type of mask had a lower risk of anxiety symptoms (aOR = 0.78; 95%CI: 0.76-0.80). Students who adhered to proper behavior of mask wearing was associated with 34% decreased odds for anxiety symptoms (aOR = 0.68; 95%CI: 0.62-0.74). CONCLUSIONS: To conclude, proper mask wearing may be an important attribute that play a significant role in reducing the risk of anxiety symptoms among junior and senior school student. However, since this study is a cross-sectional study, prospective studies are needed to further verify.

Prevalence and associated factors of anxiety among 538,500 Chinese students during the outbreak of COVID-19: A web-based cross-sectional study.

This study was conducted on elementary school students in Henan Province, China, from February 4th to 11th, 2020, during the coronavirus disease 2019 (COVID-19) epidemic. The purpose of the study was to examine the prevalence of anxiety among students and identify the related risk factors contributing to anxiety. Demographic information and psychological status were assessed by using self-reported measures. The generalized anxiety disorder tool (GAD-7) and a multiple logistic regression model were used to assess anxiety and identify potential influencing factors. Cross-sectional data indicated that the overall anxiety prevalence was 13.4%. The prevalence of anxiety symptoms was highest among rural primary school students and lowest among city students. Three groups of students in different regions were surveyed, and the prevalence of anxiety symptoms was significantly higher among students with poor knowledge of COVID-19 than among students with good knowledge of COVID-19. After adjusting for potential confounding factors, it was found that location, knowledge, and practice were related to anxiety. This study showed that the prevalence of anxiety symptoms was higher among Chinese primary school students. The influencing factors found in this study may help relevant staff improve the mental health of children during the epidemic.

Potential effect of antiseptic mouthwash on the incidence of Neisseria gonorrhoeae among men who have sex with men: a mathematical modelling study.

OBJECTIVES: The incidence of Neisseria gonorrhoeae and its antimicrobial resistance is increasing in many countries. Antibacterial mouthwash may reduce gonorrhoea transmission without using antibiotics. We modelled the effect that antiseptic mouthwash may have on the incidence of gonorrhoea. DESIGN: We developed a mathematical model of the transmission of gonorrhoea between each anatomical site (oropharynx, urethra and anorectum) in men who have sex with men (MSM). We constructed four scenarios: (1) mouthwash had no effect; (2) mouthwash increased the susceptibility of the oropharynx; (3) mouthwash reduced the transmissibility from the oropharynx; (4) the combined effect of mouthwash from scenarios 2 and 3. SETTING: We used data at three anatomical sites from 4873 MSM attending Melbourne Sexual Health Centre in 2018 and 2019 to calibrate our models and data from the USA, Netherlands and Thailand for sensitivity analyses. PARTICIPANTS: Published available data on MSM with multisite infections of gonorrhoea. PRIMARY AND SECONDARY OUTCOME MEASURES: Incidence of gonorrhoea. RESULTS: The overall incidence of gonorrhoea was 44 (95% CI 37 to 50)/100 person-years (PY) in scenario 1. Under scenario 2 (20%-80% mouthwash coverage), the total incidence increased (47-60/100 PY) and at all three anatomical sites by between 7.4% (5.9%-60.8%) and 136.6% (108.1%-177.5%). Under scenario 3, with the same coverage, the total incidence decreased (20-39/100 PY) and at all anatomical sites by between 11.6% (10.2%-13.5%) and 99.8% (99.2%-100%). Under scenario 4, changes in the incidence depended on the efficacy of mouthwash on the susceptibility or transmissibility. The effect on the total incidence varied (22-55/100 PY), and at all anatomical sites, there were increases of nearly 130% and large declines of almost 100%. CONCLUSIONS: The effect of mouthwash on gonorrhoea incidence is largely predictable depending on whether it increases susceptibility to or reduces the transmissibility of gonorrhoea.

Mental health of new undergraduate students before and after COVID-19 in China.

The purpose of this study was to examine the changes in severity of anxiety and depression symptoms, stress and sleeping quality after three months of mass quarantine for COVID-19 among undergraduate fresh students compared to their pre-COVID-19 measures. We used participants from the Chinese Undergraduate Cohort (CUC), a national prospective longitudinal study to examine the changes in anxiety and depression symptoms severity, stress and sleep quality after being under mass quarantine for three months. Wilcoxon matched pair signed-rank test was used to compare the lifestyle indicators. Severity of anxiety, depression symptoms, stress and sleep quality were compared with Wilcoxon signed-rank test. We used generalized estimating equation (GEE) to further quantify the change in mental health indicators and sleep quality after the COVID-19 mass quarantine compared to baseline. This study found that there was no deterioration in mental health status among Chinese new undergraduate students in 2020 after COVID-19 mass quarantine compared with the baseline measures in 2019. There was an improvement in sleep quality and anxiety symptoms. After adjusting for age, sex, exercise habit, time spent on mobile gadgets, and time spent outdoors, year 2020 was significantly associated with severity of depression symptoms in males (OR:1.52. 95%CI:1.05-2.20, p-value = 0.027). Year 2020 was significantly associated with the improvement of sleeping quality in total (OR:0.45, 95%CI:0.38-0.52, p < 0.001) and in all the subgroups. This longitudinal study found no deterioration in mental health status among Chinese new undergraduate students after three months of mass quarantine for COVID-19.

Prevalence and Factors for Anxiety during the COVID-19 Pandemic among College Students in China.

BACKGROUND: Knowledge of the impact of COVID-19 on the mental health of college students remains limited. Our aim is to investigate the prevalence of anxiety and explore the potential risk and protective factors of anxiety. METHODS: A cross-sectional survey was adopted and a total of 24,678 college students were included from Zhengzhou, Henan Province, China, during February, 2020. Anxiety was assessed by using the Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression models were established for exploring potential factors of anxiety. RESULTS: The overall prevalence of anxiety was 7.3%. After adjusting for potential confounders, sex, place of residence, worried level, fear level, cognitive levels, and behavior status were found to be associated with anxiety (p < 0.05). Students with positive preventive behaviors showed a protective effect against the anxiety symptoms compared to those with negative preventive behaviors. In contrast to the high-cognition category, participants at a low cognitive level were 14.9% more likely to present anxiety symptoms. CONCLUSION: This large-scale study assessed the prevalence of anxiety and its potential influencing factors among college students. It suggests that the government could strengthen health education related to COVID-19 and supervise the performance of preventive behaviors to handle anxiety.

Prevalence and risk factors for anxiety symptoms during the outbreak of COVID-19: A large survey among 373216 junior and senior high school students in China.

BACKGROUND: The increasing menace of the COVID-19 epidemic led to an atmosphere of anxiety around the world, however the evidence among Chinese students aged 12 to 18 years has been limited. METHODS: A total of 373216 junior and senior high school students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, during February 4-12, 2020. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the potential risk factors. RESULTS: Among the participants, junior and senior high school students were found to have anxiety symptoms, producing an overall prevalence of 9.89%. The prevalence was lower in female than in male (9.66% vs. 10.11%) and the prevalence was higher for junior high school students than senior high school students (13.89% vs. 12.93%). The prevalence of anxiety symptoms was highest among rural students and lowest among urban students (11.33% vs. 8.77%). The cognitive level was negatively associated with the prevalence of anxiety symptoms. After adjusting for potential confounders, age, gender, residential location, worried level, fear level and behavior status were found to be associated with anxiety symptoms. LIMITATIONS: Prevalence may be skewed by assessing anxiety symptoms using self-reported scales rather than clinical interviews. CONCLUSIONS: This large-scale study assesses the prevalence of anxiety symptoms and its potential influencing factors in junior and senior high school students. These findings suggest that governments need to pay more attention to the mental health of young people in combating COVID-19.