Prevalence of anxiety symptoms among Chinese university students amid the COVID-19 pandemic: A systematic review and meta-analysis

A network analysis of the heterogeneity and associated risk and protective factors of depression and anxiety among college students

BACKGROUND

Comorbidity of depression and anxiety is common among adolescents and can lead to adverse outcomes. However, there is limited understanding of the latent characteristics and mechanisms governing these disorders and their interactions. Moreover, few studies have examined the impacts of relevant risk and protective factors.

METHODS

This cross-sectional study involved 1,719 students. Mplus 8.0 software was used to conduct latent profile analysis to explore the potential categories of depression and anxiety comorbidities. R4.3.2 software was used to explore the network of core depression and anxiety symptoms, bridge these disorders, and evaluate the effects of risk and protective factors.

RESULTS

Three categories were established: "healthy" (57.8%), "mild depression-mild anxiety" (36.6%), and "moderately severe depression-moderate anxiety" (5.6%). "Depressed mood", "nervousness", and "difficulty relaxing" were core symptoms in both the depression-anxiety comorbidity network and the network of risk and protective factors. Stress perception and neuroticism serve as bridging nodes connecting some symptoms of depression and anxiety and are thus considered the most prominent risk factors.

CONCLUSIONS

According to the core and bridging symptoms identified in this study, targeted intervention and treatment can be provided to groups with comorbid depression and anxiety, thereby reducing the risk of these comorbidities in adolescents.

The longitudinal relationships between problematic smartphone use and anxiety symptoms among Chinese college students: A cross-lagged panel network analysis

Anxiety and problematic smartphone use (PSPU) are prevalent issues among college students, and traditional research has tended to focus on cross-sectional data and grounded only in overall levels, thereby ignoring the complex interactions between the two over time. The development of network analysis methods has provided a new perspective for in-depth exploration of the relationship. This study aimed to explore the complex longitudinal interactions and specific pathways between problematic smartphone use and anxiety among Chinese college students from an internal specific symptom perspective. This study constructed a cross-lagged network model using longitudinal data on problematic smartphone use and anxiety symptoms in two waves of college students collected from 2022 to 2023 (N=741, Mage = 18.49, SD=0.81, 45.6 % male). The study found that anxiety symptoms and problematic smartphone use interacted with each other and had a vicious cycle of symptoms over time, with the effects of anxiety symptoms being more pronounced. "Feeling afraid" and "Uncontrollable worrying" had the most significant effects on the other symptoms, with "Impatient without the phone" and "Can't stand not having a phone" were more likely to be influenced by other symptoms. "Feeling afraid" may be a bridge symptom in the network to connect the anxiety and problematic smartphone use communities. The findings suggest that accurately intervening in the intrinsic link between problematic smartphone use and anxiety symptoms can combat the exacerbation of both problems simultaneously, resulting in more effective and comprehensive treatment.

Willingness of medical students to work on the COVID-19 frontline during the pandemic in China: A nationwide population-based cross-sectional study

Background

The World Health Organization declared that coronavirus disease 2019 (COVID-19) constitutes an international public health emergency, which has strained health resources. In this study, we aimed to understand medical students' willingness to join the workforce fighting against the COVID-19 pandemic and identify factors associated with their decisions.

Methods

We conducted a nationwide cross-sectional study using the Wen-Juan-Xing platform and a pre-designed questionnaire from 23 March to 19 April 2021. We conducted logistic regression analyses to identify the determinants associated with the willingness.

Results

Among the 5022 medical students, the majority (n = 4289, 85.40%) expressed willingness to work on the COVID-19 frontline. Logistic regression indicated that medical students' willingness to work on the COVID-19 frontline in China was associated with gender, region, reason for choosing medicine, having medical workers in the family, students whose family members, relatives or friends experienced COVID-19, and professional attitude. Females (odds ratio (OR) = 1.305; 95% confidence interval (CI) = 1.100-1.549; P = 0.0023), medical students from urban areas (OR = 1.295; 95% CI = 1.089-1.539; P = 0.0034), medical students whose choice of a medical career was their desire (OR = 1.579; 95% CI = 1.290-1.933; P < 0.0001), medical students whose parents or relatives are medical workers (OR = 1.266; 95% CI = 1.066-1.505; P = 0.0073), medical students whose family members, relatives, or friends have never been infected with COVID-19 (OR = 4.567; 95% CI = 3.002-6.947; P < 0.0001), and medical students with undisturbed of professional attitudes (OR = 4.280; 95% CI = 3.241-5.654; P < 0.0001) showed increased willingness to work on the COVID-19 frontline compared with their counterparts.

Conclusions

Medical students demonstrated a strong willingness to contribute to COVID-19 work during the pandemic in China. The findings may provide valuable information for emergency management so that policymakers can maintain sufficient health resources and provide quality health care in similar health emergencies in the future.

The relationship between physical activity and psychological sub-health among high altitude region Tibetan college students

Background

The reduction in moderate to vigorous physical activity (MVPA) and the increased prominence of psychological sub-health (PSH) have had a serious negative impact on the health of Tibetan college students. Few studies have been conducted on college student populations at high altitude region in China. Therefore, the study investigated MVPA and PSH in 8721 Tibetan college students to analyze the relationship that exists between them.

Methods

In this study, subjects were selected by cluster sampling method, and 8,721 high altitude region Tibetan college students were questioned about MVPA, PSH, family situation, BMI, and lifestyle. One-way ANOVA, chi-square test, and stepwise logistic regression analysis were used to analyze the relationship between MVPA and PSH.

Results

The proportion of Chinese Tibetan college students at high altitude region with MVPA duration ≤30 Mins/Day, 31-60 Mins/Day, and ≥ 61 Mins/Day were 76.7, 18.7, and 4.7%, respectively. The proportion of Tibetan college students in China experiencing PSH was 16.41%. The percentage of emotional symptoms, behavioral symptoms, and social adaptation difficulties were 17.61, 18.04, and 14.59%, respectively. Logistic regression analysis showed that after adjusting for relevant covariates, Tibetan college students with MVPA ≤30 Mins/Day had a higher odds ratio of PSH compared to college male students with MVPA ≥61 Mins/Day (OR = 2.95, 95% CI: 1.79,4.84). In contrast, there was no significant relationship between MVPA and PSH in college females. Overall, Tibetan college students with MVPA ≤30 Mins/Day had a higher odds ratio of PSH compared to Tibetan college students with MVPA ≥61 Mins/Day (OR = 2.99, 95% CI: 2.00,4.47).

Conclusion

Chinese Tibetan college students from high altitude region areas had lower levels of MVPA and higher rates of PSH. There is an relationship between MVPA time and PSH among high altitude region Tibetan college students, and the incidence of PSH is higher among high altitude region Tibetan college students with shorter MVPA time.

Psychosomatic health status and corresponding comorbid network analysis of college students in traditional Chinese medicine schools

Introduction

Depression, anxiety, and somatic symptoms are highly comorbid and represent the most prevalent psychosomatic health issues. Few studies have investigated the network structure of psychosomatic symptoms among traditional Chinese medicine (TCM) students. This study aims to investigate the psychosomatic health status of college students in TCM universities, while simultaneously constructing a network structure of common somatic symptoms and psychological symptoms.

Methods

Online investigation was conducted among 665 students from a university of Chinese medicine. Health Status Questionnaire, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-2 (PHQ-2) were used to assess the mental symptoms and physical status of participants. With the R software processing, a network model of psychosomatic symptoms was constructed. Specifically, we computed the predictability (PRE), expected influence (EI), and bridging expected influence (BEI) of each symptom. Meanwhile, the stability and accuracy of the network were evaluated using the case-deletion bootstrap method.

Results

Among the participants, 277 (41.65%) subjects exhibited depressive symptoms, and 244 (36.69%) subjects showed symptoms of anxiety. Common somatic symptoms included fatigue, forgetfulness, sighing, thirst, and sweating. Within the psychosomatic symptoms network, " worrying too much about things ", "uncontrollable worries" and "weakness" exhibited the high EI and PRE, suggesting they are central symptoms. " Little interest or pleasure in doing things," " feeling down, depressed, or hopeless," " dyssomnia," and "sighing" with high BEI values demonstrated that they are bridging symptoms in the comorbid network.

Conclusion

The psychosomatic health status of college students in traditional Chinese medicine schools is concerning, showing high tendencies for depression, anxiety, and somatic symptoms. There exists a complex relationship between somatic symptoms and psychological symptoms among students. " Worrying too much about things ", "uncontrollable worries" and "weakness" enable to serve as comorbid intervention targets for anxiety, depression, and somatic symptoms. Addressing " little interest or pleasure in doing things," " feeling down, depressed, or hopeless," " dyssomnia," and "sighing" may effectively prevent the mutual transmission between psychological and physical symptoms. The network model highlighting the potential targeting symptoms to intervene in the treatment of psychosomatic health.

Impact of campus closure during COVID-19 on lifestyle, educational performance, and anxiety levels of college students in China

BACKGROUND

Higher education students exhibit heightened sensitivity to environmental changes as they navigate the critical transition from adolescence to adulthood. The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to universities worldwide, exemplifying a crisis that profoundly affects the learning outcomes and psychological status of college students. Although it is known that campus lockdown has triggered dramatic changes in lifestyles, learning outcomes, and psychological statuses, in-depth knowledge of the causal relationships among these changes remains largely unclear.

METHODS

Here, we conducted a cross-sectional survey designed to assess the impact of campus closure during COVID-19 on lifestyle, educational performance, and anxiety levels among college students. We surveyed over 3,500 junior college, undergraduate and graduate participants from 94 colleges/universities across 30 provinces, municipalities, and autonomous regions in China.We employed structural equation modeling (SEM) to explore the relationships between changes in lifestyle, educational performance, and levels of anxiety associated with campus open or closure regulations during the COVID-19 pandemic.

RESULTS

Our results discovered that sleep duration, physical activity involvement, and social connections were crucial for sustaining students' learning outcomes and mental health. The shift to online learning and campus lockdown exacerbated stressors, contributing to heightened anxiety (β = 0.066), disrupted sleep patterns, and enhanced physical activity (β = 0.070) and reduced learning effect (β = -0.059). Sleep patterns were disrupted by the campus lockdown, an effect mediated by the degradation of relationships among classmates. Nonetheless, the best-fitting SEM uncovered the intricate relationships among lifestyle changes, learning outcomes, and psychological status in response to sudden environmental changes (Fisher's C = 80.949, P = 0.328). These results highlight the critical role of adaptable, supportive campus policies tailored to meet the diverse needs and interests of students during and beyond crises (Fisher's C = 59.568, P = 0.809).

CONCLUSIONS

Our study advocates for a holistic approach that addresses the multifaceted aspects of student life to cultivate a resilient academic community. This approach contributes to a deeper understanding of the effects of sudden environmental changes on students' psychological well-being and academic performance in the post-pandemic era.

Have the effects of Covid-19 been overcome? Levels of Covid-19 fear, Covid-19 anxiety and hopelessness in young adolescents: A structural equation modeling

OBJECTIVE

This research aimed to determine the level of fear, anxiety, and hopelessness of Covid-19 in young adolescents' post Covid-19 period.

DESIGN AND SAMPLES

Young adolescents in the 17-24 age group were included in this study, which was conducted in a descriptive-cross-sectional design.

MEASUREMENTS

Sociodemographic characteristics questionnaire form and Coronavirus (Covid-19) Fear Scale, Coronavirus Anxiety Scale, and Beck Hopelessness Scale were used to collect data.

RESULTS

90.8% of the participants had been vaccinated, 26.9% had previously caught in Covid-19, and 10.3% of those who had been caught in the disease had a severe course. 10.7% of young adolescents had to take medicines, 56.4% had a family history of Covid-19, and 18.7% had lost a relative as a result of Covid-19, was found. The level of fear, anxiety and hopelessness was higher among women, first-grade students, those who did not receive the Covid-19 vaccine, those who have caught in Covid-19 before, and those who have lost a family due to Covid-19.

CONCLUSION

It is thought that the increase in the awareness level of young adolescents about Covid-19 improves preventive health behaviors and enables the development of positive behaviors related to the disease.

Fitness promotion in college: the relationships among students' perceived physical literacy, knowledge, and physical fitness

Purpose

The purpose of this study was to examine the relationships among perceived physical literacy (PPL), knowledge of physical activity and fitness (PAF knowledge), and physical fitness.

Methods

Undergraduates (N = 968, female = 414; Mage = 18.64) from a public university in central China completed a simplified Chinese version of the PPL instrument, an online test for PAF knowledge, and seven health-related physical fitness tests. The PPL includes three dimensions: (a) confidence and physical competence, (b) motivation, and (c) interaction with the environment. The fitness tests measured lung capacity, body mass index (BMI), and performances in 800 (female)/1000 (male) meters run, 50 meters dash (50 M), sit-up (female) / pull-up (male), standing long jump (SLJ), and sit-and-reach.

Results

PPL and its dimensions significantly predicted six fitness test performances both in male (β: -0.42 - 0.37; p < 0.01-0.05; R2: 0.01-0.13) and female (β: -0.59 - 0.49; p < 0.01-0.05; R2: 0.03-0.13) students. PAF knowledge (β: -0.17 - 0.18; p < 0.01-0.05; R2: 0.01-0.05) significantly predicted BMI (males) and performances in 50 M (females) and SLJ (females) tests.

Conclusion

To support college students' fitness development and maintenance, tailored physical activity and fitness promotion programs are needed to strengthen students' PPL and PAF knowledge.

Mental health disorders among medical students during the COVID-19 pandemic in the area with no mandatory lockdown: a multicenter survey in Tanzania

The COVID-19 pandemic brought about a major public health concern worldwide. It forced many countries to enforce lockdowns, leading to the closure of higher learning institutions. The abrupt shift in the lifestyle of students had a profound impact on their mental health. This study aims to determine the prevalence and factors associated with mental health conditions among university students in Tanzania during the COVID-19 pandemic. A sample of 425 students from six medical universities and colleges in Tanzania completed an online survey and was included in the analysis. The questionnaire consisted of validated Depression, Anxiety and Stress Scale-21 Items (DASS-21) questions (Cronbach's alpha = 0.92) assessing the presence of mental health symptoms: depression, anxiety, and stress. Multivariable logistic regression models were fitted to explain the factors associated with mental health conditions. A P-value < 0.05 was considered statistically significant in all inferential analyses. The median age (interquartile range) of the participants was 24 (22-26). The prevalence of mental health conditions was 28.94%, 54.12%, and 15.06% for depression, anxiety, and stress, respectively, while the prevalence of having any mental health condition was 58.59%. In an adjusted regression model, being in the fourth and fifth years of study and living with a spouse were significantly associated with increased odds of depression: AOR = 5.99 (1.31-27.47), AOR = 5.52 (1.18-25.81), and AOR = 1.84 (1.08-3.15), respectively. Moreover, studying in private universities and living with a spouse were significantly associated with an increased likelihood of anxiety: AOR = 2.35 (1.72-2.76), and AOR = 2.32 (1.20-4.50), respectively. The likelihood of stress was only among participants studying in private universities; AOR = 2.90 (1.60-5.27). The study revealed alarmingly high rates of mental health conditions among medical students in Tanzania during the COVID-19 pandemic. The findings suggest the need for regular checkups for medical students regarding their mental health status. Additionally, it recommends that the government and other stakeholders establish mental health services within the universities for the effective prevention of the rising burden of mental health problems among universities in Tanzania and other countries with similar settings.

The relationship between self-control and mental health problems among Chinese university students

Background

Mental health issues are often associated with poor self-control. Therefore, effective interventions against mental health problems should include self-control training. However, it is unclear whether the effect of self-control varies across different types of mental health problems.

Methods

A cross-sectional survey was conducted using the convenience sampling method at five universities in Chongqing, China, where 1,409 students reported their demographic information, level of self-control, and symptoms of irritability, depression, and anxiety. Descriptive statistical methods and a network analysis approach were employed to explore the relationship between self-control and symptoms of irritability, depression, and anxiety among 1,409 students. The bridging links between self-control and the three mental health problems were analyzed.

Results

The findings revealed a negative correlation between self-control and symptoms of irritability, depression, and anxiety among university students. Impulse control was found to be the bridge between self-control and irritability or anxiety symptoms, while resistance to temptation was the bridge between self-control and depressive symptoms.

Conclusion

These results demonstrate the different relationship between self-control with irritability, anxiety, and depressive symptoms. The findings of this study may shed light on future mental health interventions for university students during potential public health emergencies, such as prior knowledge of the main types of psychological problems among university students, which may allow for the development of precise self-control intervention strategies, such as targeting impulsivity or resistance to temptation.

Anxiety, Depression, and PTSD among College Students in the Post-COVID-19 Era: A Cross-Sectional Study

In the post-COVID-19 era, significant changes have taken place regarding the epidemic, the economy, family and social life. However, it remains unclear how these changes encompass the psychological symptoms of college students. We carried out a cross-sectional study to investigate anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms among college students from 10 November 2020, to 16 November 2020. The questionnaire included a self-designed canvas, Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), and Impact of Event Scale (IES-R). Factors associated with psychological symptoms were estimated by ordered and non-conditional logistic regression analysis. Of 4754 participants, 25.0%, 29.7%, 3.4%, 15.3%, 17.1%, and 2.9% reported anxiety, depression, PTSD symptoms, one, any two, and all three, respectively. In cases with anxiety or depression symptoms, there was a 9.11% comorbidity with PTSD. Factors associated with fears of being infected, social, family, and economic changes increased the risk of psychological symptoms in college students caused by COVID-19. Female college students, identified with anxiety or depression symptoms, were at a lower risk of developing PTSD symptoms (OR, 0.61, 95% CI: 0.43-0.86). Non-medical majors at university, rural residence, higher educational background, fear of taking public transport, and deterioration of family relationships increased the risk for PTSD symptoms among male respondents with anxiety or depression symptoms due to COVID-19. Factors correlated with psychological symptoms had expanded from the fear of being infected to extensive social, family, and economic changes caused by COVID-19. Therefore, screening and interventions for psychological symptoms should be consistently strengthened and more targeted to college students in the post-COVID-19 era.