Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted university teaching globally. The mental health impacts on international university students have been overlooked.Aims: This study examined the differences in COVID-19-related stressors and mental health impacts between international university students studying in the UK or USA who returned to their home country or region (returnees) and those who stayed in their institution country (stayers), and identified COVID-19-related stressors and coping strategies that were predictors of mental health.Method: An online questionnaire survey was conducted from April 28 through May 12, 2020 using an exponential, non-discriminative snowball sampling strategy (registered at the National Institutes of Health: NCT04365361).Results: A total of 124 full-time international university students (36.3% male) were included: 75.8% had returned to their home country or region for reasons related to COVID-19; 77.4% were pursuing a bachelor's program, and 53.2% were in programs with practicum component. 84.7% of all students had moderate-to-high perceived stress, 12.1% had moderate-to-severe symptoms of anxiety and depression, and 17.7% had moderate-to-severe symptoms of insomnia. Compared with returnees, stayers had significantly higher stress from COVID-19-related stressors such as personal health and lack of social support (Cohen's d: 0.57–1.11), higher perceived stress [10-item Perceived Stress Scale (PSS-10)] {22.6 ± 6.2 vs. 19.1 ± 6.1, β [95% confidence interval (CI)]: 4.039 (0.816, 7.261), Cohen's d: 0.52}, and more severe insomnia symptoms [Insomnia Severity Index (ISI)] [11.8 ± 6.1 vs. 7.6 ± 5.2, β (95% CI): 3.087 (0.262, 5.912), Cohen's d: 0.45], with moderate-to-large effect sizes. Compared with males, females reported significantly higher stress from uncertainties about academic program (Cohen's d: 0.45) with a small effect size. In the total sample, stress related to academics (e.g., personal attainment, uncertainties about academic program, and changes in teaching/learning format), health (including personal health and health of family and friends), availability of reliable COVID-19-related information, and lack of social support predicted more negative mental health impacts. Resilience, positive thinking, and exercise were predictors of less severe mental health impacts.Conclusions: Stayers experienced more adverse mental health impacts than returnees. We call on educators and mental health professionals to provide appropriate support for international students, particularly the stayers, during the pandemic.

Pandemic fatigue is a growing public health concern of the lingering COVID-19 pandemic. Despite its widespread mass media coverage, systematic empirical investigations are scarce. Under the Hong Kong Jockey Club SMART Family-Link Project, we conducted online and telephone surveys amid the pandemic in February to March 2021 to assess self-reported pandemic fatigue (range 0–10) in Hong Kong adults (N = 4726) and its associations with sociodemographic and psycho-behavioral (high vs low to moderate) variables. Data were weighted by sex, age, and education of the general population. Binary logistic regression models yielded adjusted odds ratios (aORs) for high pandemic fatigue (score ≥ 7) for sociodemographic and psycho-behavioral variables. 43.7% reported high pandemic fatigue. It was less common in older people (55–64 years: aOR 0.56, 95% CI 0.39–0.82; 65 + years: 0.33, 0.21–0.52) versus age group 18–24 years, but more common in those with tertiary education (1.36, 1.15–1.62) versus secondary or below. High pandemic fatigue was positively associated with depressive symptoms (aOR 1.83, 95% CI 1.55–2.17), anxiety symptoms (1.87, 1.58–2.20), loneliness (1.75, 1.32–2.31), personal fear of COVID-19 (2.61, 2.12–3.23), family fear of COVID-19 (2.03, 1.67–2.47), and current alcohol use (1.16, 1.00–1.33), but negatively associated with self-rated health (0.79, 0.68–0.92), personal happiness (0.63, 0.55–0.72), personal adversity coping capability (0.71, 0.63–0.81), family adversity coping capability (0.79, 0.69–0.90), family well-being (0.84, 0.73–0.97), family communication quality (0.86, 0.75–0.98), and frequent home exercise (0.82, 0.69–0.96; versus less frequent). We first used a single-item tool to measure COVID-19 pandemic fatigue, showing that it was common and associated with worse mental health, lower levels of personal and family well-being and alcohol use.

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Background Adversity coping capability (ACC) is important amid the COVID-19 pandemic. We examined the associations of ACC as measured by our one-item ACC scale (ACC-1) with mental health, family well-being and validity of ACC-1 in Hong Kong. Methods A cross-sectional survey was conducted on Hong Kong Chinese adults aged ≥ 18 years by landline, mobile phone, and online survey from February to March 2021, when the fourth wave of COVID-19 was under control. ACC-1 consisted of the question: “How do you rate your capability to cope with adversities?” with higher scores (0–10) indicating stronger ACC. The associations of ACC with socioeconomic characteristics, resilience, mental health, and family wellbeing were examined by linear regression coefficients (βs). Data were weighted by sex, age, and education of the general population. Results Of 7441 respondents, after weighing, 52.2% were female and 79.1% were aged 18 to 64 years. ACC-1 showed good construct validity, with higher ACC being associated with higher levels of resilience (adjusted β = 0.29), personal happiness (0.55), family happiness (0.42), family wellbeing (0.41), and family communication quality (0.41), and lower levels of depressive symptoms (-0.30), anxiety (-0.30), loneliness (-0.15); incremental validity with additional contributions of ACC to mental health and family wellbeing; and known-group validity with older age and favorable socioeconomic characteristics showing higher ACC (all P < 0.02). Females (mean ± standard deviation: 6.04 ± 1.82 vs 6.15 ± 1.96 [male]) and unemployed respondents (5.30 ± 1.99 vs 6.11 ± 2.03 [in paid employment]) had lower ACC (all P ≤ 0.02). Conclusions We have first shown that stronger ACC was associated with better mental health and family wellbeing, and the results support ACC-1 as a simple and valid measure of ACC.

ObjectiveWe assessed the associations of family wellbeing with verifying and subsequently forwarding COVID-19-related information to family members and the mediating effect of the quality of family communication on these associations among Chinese adults in Hong Kong.MethodsUnder the Jockey Club SMART Family-Link Project, we conducted an online population-based survey, using Family wellbeing Scale and questions related to the family communication quality and forwarding and verifying COVID-19 information. Data were collected from 4,891 adults in May 2020. Prevalence estimates of forwarding and verifying COVID-19 information were weighted by sex, age, and education of the general population, and their associations with family wellbeing (ranged 0–10) were analyzed using generalized linear models with mutual adjustment. Their interactive effects on family wellbeing and the mediating effects of family communication quality were examined.ResultsIn total, 53.9% of respondents usually/always forwarded COVID-19 information related to their family, 68.7% usually/always verified it before forwarding, and 40.9% did both. Greater family wellbeing was associated with usually/always forwarding [adjusted β (95% CI): 0.82 (0.72–0.92)] and usually/always verifying [0.43 (0.32–0.55)] (both P &lt; 0.001) the information. Forwarding and verifying such information showed an additive effect on family wellbeing [1.25 (1.11–1.40)]. Family communication quality mediated the associations of family wellbeing with forwarding (83.7%) and verifying (86.6%) COVID-19-related information.ConclusionForwarding COVID-19 information to family, verifying such information, and especially doing both, were associated with greater family wellbeing, being strongly mediated by the quality of family communication. Individuals should be encouraged to verify COVID-19-related information before forwarding it to family members amidst the COVID-19 pandemic.

BackgroundWe have reported both perceived benefits and harms of the COVID-19 outbreak and their socioeconomic disparities amid the pandemic in Hong Kong. We further investigated whether such perceptions and disparities had changed after 10 months.MethodsUnder the Hong Kong Jockey Club SMART Family-Link Project, we conducted two cross-sectional surveys online on perceived personal and family benefits and harms of the COVID-19 outbreak in Hong Kong adults in May 2020 (after Wave 2 was under control; N = 4,891) and in February and March 2021 (after Wave 4 was under control; N = 6,013). We collected sociodemographic information, including sex, age, education, household income, and housing. Using multivariate models of analysis of covariance (MANCOVA), we compared perceived benefits and harms and socioeconomic disparities between the two surveys.ResultsAdjusting for sex and age, the prevalence of 17 out of 18 perceived personal and family benefits of COVID-19 outbreak increased (Ps &lt; 0.001). Six of 11 perceived personal and family harms decreased (Ps &lt; 0.001) and 4 increased (Ps &lt; 0.001). The total number of perceived personal and family benefits increased substantially (Ps &lt; 0.001), whereas that of perceived personal harms decreased (P = 0.01) and family harms remained stable (P &gt; 0.05). Socioeconomic disparities, however, persisted—more perceived benefits in those with higher socioeconomic status (Ps &lt; 0.001) and more perceived harms in those with lower (Ps ≤ 0.005).ConclusionWe have first reported that perceived personal and family benefits of the COVID-19 outbreak increased substantially over 10 months amid the pandemic, while perceived personal and family harms were lower and stable, respectively. Socioeconomic disparities of the perceived benefits and harms persisted, which need to be monitored and addressed urgently.

ObjectiveFamily services are open to the community at large as well as vulnerable groups; however, little is known about the willingness of communities to attend such services. We investigated the willingness and preferences to attend family services and their associated factors (including sociodemographic characteristics, family wellbeing, and family communication quality) in Hong Kong.MethodsA population-based survey was conducted on residents aged over 18 years from February to March 2021. Data included sociodemographic characteristics (sex, age, education, housing type, monthly household income, and the number of cohabitants), willingness to attend family services to promote family relationships (yes/no), family service preferences (healthy living, emotion management, family communication promotion, stress management, parent-child activities, family relationship fostering, family life education, and social network building; each yes/no), family wellbeing, and family communication quality (both scores 0–10). Family wellbeing was assessed using the average scores of perceived family harmony, happiness and health (each score 0–10). Higher scores indicate better family wellbeing or family communication quality. Prevalence estimates were weighted by sex, age and educational level of the general population. Adjusted prevalence ratios (aPR) for the willingness and preferences to attend family services were calculated in relation to sociodemographic characteristics, family wellbeing, and family communication quality.ResultsOverall, 22.1% (1,355/6,134) and 51.6% (996/1,930) of respondents were willing to attend family services to promote relationships or when facing problems, respectively. Older age (aPR = 1.37–2.30, P &lt; 0.001–0.034) and having four or more cohabitants (aPR = 1.44–1.53, P = 0.002–0.003) were associated with increased aPR of willingness for both situations. Lower family wellbeing and communication quality were associated with lower aPR for such willingness (aPR = 0.43–0.86, P = 0.018–&lt;0.001). Lower family wellbeing and communication quality were associated with preferences for emotion and stress management, family communication promotion, and social network building (aPR = 1.23–1.63, P = 0.017–&lt;0.001).ConclusionsLower levels of family wellbeing and communication quality were associated with unwillingness to attend family services and preferences for emotion and stress management, family communication promotion, and social network building.

Sports injuries can be reduced by taking basic precautionary steps such as using protective gear, warming-up, and adjusting training strategies. 1 However, despite the continuing endeavor in sport injury prevention, sport injury still ranked highly as the most common injury among youth and adolescents. 2 This is because the effectiveness