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.

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.

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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.

Background During the COVID-19 pandemic, college students were required to stay at home and maintain social distancing the entire spring semester of 2020. There is little research on how family function influenced mental health problems and how coping styles moderated the relationship between family function and mental health problems among college students during their stay-at-home period. Methods We carried out four evaluations between February and October 2020 through an online survey. A total of 13,462 college students (age = 16–29 years) participated. Family function, coping styles, depression symptoms, and anxiety symptoms were studied. To evaluate the associations between variables, a generalized estimating equation was used. Results Findings indicate that the incidence rates of depression rose during 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 rose from 17.45%, 95% CI (14.59%, 20.73%) to 26.53%, 95% CI (16.94%, 23.67%) through the entire period, χ2 = 195.74, p < 0.001. The incidence rate of depression and anxiety for different family function groups varied at different time points, 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 function 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 These findings shed light on how family function intersected with coping styles to influence the mental health problems of college students during and after the stay-at-home period of COVID-19. These findings highlight the importance of paying special attention to college students' family function and promoting appropriate coping strategies during and after COVID-19.