ABSTRACT
BACKGROUND: After emerging in China, the novel coronavirus disease 2019 (COVID-19) quickly spread to all parts of the country and became a global public health emergency. The Chinese government immediately took a series of protective and quarantine measures to prevent the spread of the virus, and these measures may have negative effects on behavior and psychological health. This study aimed to examine the associations between factors related to COVID-19 measures and mental health symptoms among Chinese college students in different pandemic areas. METHODS: An online survey was administered to 14,789 college students from February 4 to 12, 2020. After excluding the participants who did not complete the questionnaire, the quality of the questionnaire was checked. Finally, the sample included 11,787 college students from 16 cities and 21 universities in China. The areas included the city of Wuhan (Area 1), the neighboring province of Hubei (Area 2), first-tier cities (Beijing, Shanghai, and Guangzhou [Area 3]), and other provinces (Area 4). RESULTS: The average age of the participants was 20.51 ± 1.88 years. One-third of the participants were men. In total, 25.9 and 17.8% reported depression and anxiety, respectively. We also explored COVID-19-related factors, such as infection risk, perceived resistance to COVID-19 (or susceptibility to COVID-19 infection), perceived physical symptoms, family or friends, direct or indirect contact with confirmed cases, and having sought psychological counseling, which were significantly associated with anxiety and depression symptoms. Higher screen time, lower physical activity, higher soda and tea beverages (also called sugar sweetened beverages intake), use of alternative medicines or food supplements (including Chinese herbal medicines and vitamins), and decreased meal frequency were all correlated with higher depression and anxiety symptoms (depression: χ2 = 25.57 and anxiety: χ2 = 39.42). Coping with COVID-19 partially mediated the associations between some related lifestyle behaviors, anxiety, and depression. The conditional process model analysis results supported our hypotheses that lifestyle health behaviors and coping style were both predictors of anxiety and depression symptoms, and their direct and indirect effects were moderated by sex. CONCLUSIONS: Compared with the city of Wuhan, other epidemic areas had a lower risk of mental health problems. Lifestyle health behaviors and coping styles alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms.