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.

ABSTRACT

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.