Psychiatric symptoms, risk, and protective factors among university students in quarantine during the COVID-19 pandemic in China

Abstract

<jats:p>This study investigated psychiatric symptoms (depression, anxiety, and traumatic stress) during state-enforced quarantine among university students in China. We conducted a cross-sectional survey with 1,912 university students during March and April 2020. Psychiatric symptoms in the mild or higher range based on clinical cut-offs were alarmingly prevalent: 67.05% reported traumatic stress symptoms, 46.55% had depressive symptoms, and 34.73% reported anxiety symptoms. Further, 19.56% endorsed some degree of suicidal ideation. We explored factors that may contribute to poor psychological health as well as those that may function as protective factors. Risk and protective factors examined included demographic variables, two known protective factors for mental health (mindfulness, perceived social support), four COVID-specific factors (COVID-19 related efficacy, perceived COVID-19 threat, perceived COVID-19 societal stigma, COVID-19 prosocial behavior) and screen media usage. Across psychiatric symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity. COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity. Average screen media device usage was 6 hours and usage was positively associated with depression. Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms. Study limitations and implications for treatment and prevention of affective disorders during crisis are discussed.</jats:p>

Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review

“…Some pandemic-related factors were associated with increased risk of developing PTSD. Quarantine or the experience of social isolation due to pandemic [26,34,38,64,66,69,75] was a major risk factor for postpandemic PTSD, along with poor social life [47,108], economic loss [34,77,93,101], and impact on livelihood [34,36,66,78]. In addition, having high risk or perception of high risk of contracting infection was also associated with greater risk of post-pandemic PTSD.…”

“…Negative psychological responses to the infection, including feeling anxious/depressed [61,99,108], stressful [47,53,66,70], extremely fearful and helpless [47,55,71,79,86], and any other negative feelings [81], during the pandemic were all risk factors for post-pandemic PTSD. Other pandemic-related factors that increased PTSD risk included individuals having uncertainty of the possibility of contracting infection [32] and those who felt stigmatized because of the pandemic [77]. Some risk factors were specific to healthcare workers and some to patients.…”

“…Having anxious or depressive affect [61,99,108] Having uncertainty of the possibility of contracting infection [32] Perceived negative feeling toward the infection [81] Elevated stress level [47,53,66,70] Feel horrified, apprehensive and helpless/ loneliness because of infection [47,55,71,79,86] Regarding oneself as having been the target of discrimination, stigma [77] Factors specific to HCW Work in high-risk units/communities Nurses [29,71,74] Frontline [8,53,65,95,105,108] Working in a hospital or high-risk community [57] Technician (inadequate protection) [8] General practitioner [65] Nonlocal aid worker [92]…”

“…Most studies have suggested that age was another major demographic factor that contributes to higher risk of postpandemic PTSD, although in our review, different studies had inconsistent conclusions regarding which age group was more likely to be PTSD victims. Through our review, those having children, married/widowed/divorced, working in business units, and encountering economic difficulties due to the infections are at high risk of developing PTSD [34,39,43,56,67,73,77,90,93,94,101,103]. It suggests that the living conditions, responsibility, or source of stress at a given age are the "culprit" of individuals' PTSD postpandemic.…”

“…It suggests that the living conditions, responsibility, or source of stress at a given age are the "culprit" of individuals' PTSD postpandemic. Another risk factor worth our attention is perceived stigmatization or discrimination due to the pandemic [56,61,77]. Infected patients are not only the vectors of infection, but also often the victim of social stigma following the infection.…”