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Xiao QQ, Huang XH, Yang J, Wang C, Mu YF, Cai J, Deng ZY, Wang Y, Deng AP, Song HJ, Chen J, Qiu CJ, Zhang J, Li B, Long J, Meng XD, Zhang L, Huang Y, Gao R, Zhao JS, Zhang BZ, Ran MS. Effects of life rules on mental health and behavioral problems among adolescent and youth students: A survey after the lifting of COVID-19 restrictions in China. BMC Public Health 2025; 25:722. [PMID: 39984898 PMCID: PMC11846201 DOI: 10.1186/s12889-025-21968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 02/14/2025] [Indexed: 02/23/2025] Open
Abstract
OBJECTIVE To explore the impact of life rules (including individual's life habits and life patterns, such as diet, sleep, and learning styles) on mental health and behavioral problems among adolescent and youth students after the lifting of COVID-19 restrictions in Sichuan, China and analyze the influencing factors of life rules. METHODS An online survey was conducted in middle schools, high schools, colleges and universities in Sichuan Province, China, from December 14, 2022, to February 28, 2023. Demographic information, COVID-19 epidemic-related questions, behavioral and mental health information were collected. Pearson chi-square tests and One-way ANOVA were used to compare the differences of drinking/smoking, suicidal ideation and attempts, internet addiction, anxiety, depression and PTSD among groups with different life rules. Multiple logistic regression analysis was used to analyze the influencing factors of life rules. RESULTS A total of 82,873 eligible participants (aged 12-24 years) were included in this study, 40,519 participants (48.9%) reported that their life rules were partially impacted by the COVID-19 pandemic, and 6,461 participants (7.8%) reported that their life rules were severely disrupted. A total of 61.2% of participants partially recovered their life rules, and 8.6% of participants did not recover their life rules. There were statistically significant differences among different groups in terms of drinking/smoking habits, frequency of drinking/smoking in the past year, volume of drinking/smoking, internet addiction, anxiety and depression symptoms, PTSD, suicidal ideation and attempts (all P < 0.01). There were significant differences in the degree of impact and recovery of life rules among different genders, residence, grade, family economic level, home study status, academic level, infection and isolation status (all P < 0.01). CONCLUSIONS Adolescent and youth students with disrupted life rules during and after the COVID-19 pandemic had significantly more mental health and behavioral problems. Targeted and specific psychosocial interventions should be urgently needed to reduce the mental health and behavioral problems among students.
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Affiliation(s)
- Qing-Qing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xue-Hua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Jing Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Cong Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yun-Fei Mu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jia Cai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhong-Yue Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ai-Ping Deng
- School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
- West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong-Jun Song
- School of Nursing, Sichuan University, Chengdu, 610041, Sichuan, China
- West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jin Chen
- Department of Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Chang-Jian Qiu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jun Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bin Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiang Long
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xian-Dong Meng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lan Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ru Gao
- Wenjiang People's Hospital, Chengdu, 610037, Sichuan, China
| | - Jun-Shu Zhao
- Ya'an Fourth People's Hospital, Ya'an, 625000, Sichuan, China
| | - Bing-Zhi Zhang
- Ya'an Fourth People's Hospital, Ya'an, 625000, Sichuan, China
| | - Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Department of Social Psychiatry, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Yang Y, Lin Y, Wang F, Wang SJ, Wang JH, Tong F, Gong QH. Comparison of bullying victimization and depression symptoms among Chinese adolescents before and after the end of the dynamic zero-COVID-19 policy: a repeated cross-sectional study. BMC Psychiatry 2025; 25:92. [PMID: 39901119 PMCID: PMC11792695 DOI: 10.1186/s12888-025-06525-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 01/21/2025] [Indexed: 02/05/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on the physical and mental health of human beings. Most adolescents in mainland of China have been infected with COVID-19 after the adjustment of the dynamic zero-COVID-19 policy. This study aims to analyze the relationship between the COVID-19 pandemic effect and depressive symptoms among adolescents in mainland China. METHODS This school-based repeated cross-sectional study was conducted on students aged 11-19 years from September to October 2022 and September to October 2023 in Ningbo, Zhejiang Province, China, using a stratified cluster, multistage sampling method. Data analysis occurred from January to June 2024. Depression symptoms and bullying victimization, exclusion of cyberbullying, were assessed using the 20-item Center for Epidemiological Studies Depression Scale (CES-D) and Bully/Victim Questionnaire, respectively. RESULTS In the first survey wave in 2022 during the dynamic zero-COVID-19 policy period in Mainland China, 10,224 participants completed the questionnaires. In wave 2 survey in 2023 which was the first year after lifting of the dynamic zero-COVID-19 policy, 11,604 participants completed the questionnaires. This resulted in a sample of 10,224 in wave 1 and 11,604 in wave 2. The mean age in wave 1 was 15.2 (SD = 1.7) and 15.1 (SD = 1.8) in wave 2. The prevalence of depression symptoms in adolescents in wave 2 was higher than in wave 1 (17.0% vs. 14.6%, P < 0.05). The prevalence of bullying victimization and types of bullying victimization in school among adolescents were higher in 2023 than in 2022. A total of 3.2% of the 2023 participants and 1.7% of the 2022 participants experienced bullying victimization in school (P < 0.05). The odds ratio of experiencing depression (CES-D Score ≧ 16) and bullying victimization in school were 1.18 (95% CI, 1.10-1.28) and 1.86 (95% CI, 1.55-2.24) times higher, respectively, in 2023 than in 2022 (P < 0.01). The mediated regression analysis revealed that after lifting of the dynamic zero-COVID-19 had a significant association with an increase in depression symptoms, which was partially mediated by bullying victimization in school (total association:β = 0.175; SE = 0.038; P < 0.001; direct association:β = 0.138; SE = 0.039; P < 0.001; indirect association: a*b = 0.037; P < 0.001; the proportion of mediation: 20.88%, P < 0.001). CONCLUSIONS The findings of this repeated cross-sectional study suggest that an increased risk of depression symptoms or bullying victimization has been associated with the COVID-19 pandemic in mainland China after lifting the dynamic zero-COVID-19 policy. In addition, bullying victimization may play a mediating role in the associations between the pandemic and depression symptoms. These findings indicated that additional support should be offered to Chinese adolescents in the period of post-pandemic COVID-19. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Yong Yang
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, China
| | - Yi Lin
- Center for Health Economics, Faculty of Humanities and Social Sciences, University of Nottingham Ningbo China, Ningbo, Zhejiang Province, China
| | - Feng Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China
| | - Si Jia Wang
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China
| | - Jing Hui Wang
- Department of Children and Adolescents Health, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China
| | - Feng Tong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China.
| | - Qing Hai Gong
- Ningbo Municipal Center for Disease Control and Prevention, Ningbo, Zhejiang Province, China.
- Department of Children and Adolescents Health, Ningbo Municipal Center for Disease Control and Prevention, Ningbo, China.
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Yang Y, Zhang D, Li Y, Li C, Zhu L, Luo G. Sleep disorders among frontline nurses after the COVID-19 outbreak: a large-scale cross-sectional study. J Neural Transm (Vienna) 2025; 132:139-147. [PMID: 39352474 DOI: 10.1007/s00702-024-02836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 09/24/2024] [Indexed: 01/16/2025]
Abstract
This large-scale cross-sectional multicenter study aims to investigate the prevalence of sleep disorders among frontline nurses in China after the COVID-19 pandemic and to identify potential influencing factors contributing to these sleep disturbances. A total of 2065 frontline nurses from 27 provinces in China participated in an online survey conducted through the Wenjuan Xing platform. Data on demographic characteristics, work-related factors, and mental health assessments, including the Pittsburgh Sleep Quality Index (PSQI), Zung Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS), were collected. Statistical analyses, including chi-square tests, t-tests, binary logistic regression, and ROC analysis, were conducted to explore the relationships between various factors and sleep disorders. Over half (52.7%) of the surveyed nurses exhibited sleep disorders, reflecting a considerable post-pandemic impact on sleep quality. Factors such as nursing titles, personality traits, COVID-19 infection status, and exercise frequency showed statistically significant associations with sleep disorders. Extraverted nurses and those who had recovered from COVID-19 displayed a lower risk of sleep disorders, while anxiety was identified as an independent risk factor. The study also identified a nuanced relationship between exercise frequency and sleep quality. The study highlights a high prevalence of sleep disorders among frontline nurses post-COVID-19, emphasizing the need for targeted interventions. Factors such as nursing titles, personality traits, COVID-19 infection status, exercise habits, and anxiety levels were found to influence sleep quality. Comprehensive support strategies addressing these factors are essential for improving the overall well-being of frontline nurses and, subsequently, sustaining a resilient healthcare workforce. Further research is recommended to explore additional influencing factors and consider diverse nurse populations.
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Affiliation(s)
- Yuan Yang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Die Zhang
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Yuchao Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Cui Li
- Department of Civil Engineering, Nanjing Technical Vocational College, 58 Huangshan Rd., Nanjing, 210019, China
| | - Liping Zhu
- Ya'an people's Hospital, Sichuan University, Ya'an, Sichuan, 625000, China
| | - Guoshuai Luo
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China.
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Zhou L, Yu Y, Liu B, Zhou LF, Sheng J, Zhang XF, Deng XP, Ran MS. Non-suicidal self-injury among youth students during COVID-19 pandemic: the role of psychological factors in Jingzhou, China. Front Psychiatry 2024; 15:1446727. [PMID: 39234618 PMCID: PMC11371714 DOI: 10.3389/fpsyt.2024.1446727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Objective This study aimed to explore the impact of the COVID-19 pandemic on non-suicidal self-injury (NSSI) among youth students, and the mediating role of psychological factors in the relationship between the COVID-19 pandemic and NSSI. Method An online survey was conducted at junior and senior high schools, as well as universities located in Jingzhou, Hubei Province, China between June 2021 and January 2022. The COVID-19 Impact Index was constructed using multiple correspondence analysis (MCA) method. The bootstrapping method was used for mediation analysis. Results A total of 16025 youth participated in the study and 12507 youth (78.1%) finished the questionnaires. The COVID-19 Impact Index had a significantly positive effect on NSSI (r=0.16, p<0.001). The mediation analysis results showed that the COVID-19 Impact Index had a significant indirect effect on youth' NSSI (β=0.0918, 95% CI [0.0788, 0.1048]), and this indirect effect was mainly achieved through affecting youth' anxiety, depression and post-traumatic stress disorder (PTSD). The mediation effect of anxiety on NSSI was 0.0584, the direct effect was 0.0334, and the mediation proportion was 63.6%. The mediation effect of depression on NSSI was 0.0668, the direct effect was 0.0250, and the mediation proportion was 72.8%. The mediation effect of PTSD on NSSI was 0.0640, the direct effect was 0.0278, and the mediation proportion was 69.7%. All the mediation effects, direct effects and total effects were statistically significant (p<0.001). Conclusion The higher the impact of the COVID-19 Impact Index, the higher the prevalence of NSSI among youth students. Anxiety, depression and PTSD had mediated the relationship between the COVID-19 Impact Index and NSSI. It is suggested that specific health policies, mental health services and interventions should be developed to reduce the NSSI and improve mental health status among youth students during the COVID-19 pandemic.
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Affiliation(s)
- Lie Zhou
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ye Yu
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
| | - Bo Liu
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
| | - Li-Fang Zhou
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
| | - Juan Sheng
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
| | | | - Xiao-Peng Deng
- Mental Health Center of Yangtze University, Jingzhou, Hubei, China
- Mental Health Institute of Yangtze University, Jingzhou, Hubei, China
- Jingzhou Rongjun Special Care Hospital, Jingzhou, Hubei, China
| | - Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Xiao QQ, Huang XH, Yang J, Mu YF, Wang C, Deng ZY, Cai J, Deng AP, Tang WJ, Chen XC, Shi W, Jiang Y, Xu JJ, Yin L, Huang Y, Zhang W, Ran MS. Suicidal ideation and suicide attempts among students aged 12 to 24 after the lifting of COVID-19 restrictions in China: prevalence and associated factors. Front Psychiatry 2024; 15:1383992. [PMID: 38962062 PMCID: PMC11221262 DOI: 10.3389/fpsyt.2024.1383992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
Objective To investigate the prevalence and associated factors of suicidal ideation and suicide attempts among adolescent and young adults in China from December 14, 2022 to February 28, 2023, when COVID-19 restrictions were lifted. Methods Students in middle and high schools and colleges and universities in the province of Sichuan, China were asked to complete on-line cross-sectional surveys. Information was collected about sociodemographics, experiences related to the COVID-19 pandemic, suicidal ideation and suicide attempts. Participants also filled out the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 and the Social Support Rate Scale surveys. Factors associated with suicidal ideation or suicide attempts were explored using logistic regression. Results Of the 82,873 respondents (aged 12 to 24 years), 21,292 (25.7%) reported having thought of suicide at least once in their lifetime, 10,382 (12.5%) reported having thought about suicide within the previous 12 months, and 1,123 (1.4%) reported having attempted it within the previous 12 months. Risk of lifetime suicidal ideation was higher among middle school students than among older students. Risk of suicidal ideation and risk of suicide attempts correlated directly with severity of symptoms of depression and anxiety, and inversely with level of social support. Greater risk of suicidal ideation and suicidal attempts was associated with: being female, living in an urban environment, attending a boarding school, currently being in love, having parents who divorced or remarried, having parents who exhibit non-authoritative parenting behavior, having higher family income, having been COVID-19 infected, having been quarantined for a long time, and being dissatisfied with one's education. Conclusions Suicidal ideation and suicide attempts remain prevalent among young people in China. The potential associated factors identified in our study may be useful for targeting appropriate psychosocial interventions and developing mental health policies.
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Affiliation(s)
- Qing-Qing Xiao
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xue-Hua Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Jing Yang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Fei Mu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Cong Wang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong-Yue Deng
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia Cai
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ai-Ping Deng
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Wan-Jie Tang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xia-Can Chen
- Institute of Forensic Medicine, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Wei Shi
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, Sichuan, China
| | - Yi Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jia-Jun Xu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Yin
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Huang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Zhang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ran MS, Xiao Y, Rohlof H. Editorial: The impact of COVID-19 on internet addiction, suicidal behavior, and study behavior in adolescents in various cultural contexts. Front Psychiatry 2024; 15:1375244. [PMID: 38380118 PMCID: PMC10877024 DOI: 10.3389/fpsyt.2024.1375244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Mao-Sheng Ran
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunyu Xiao
- Weill Cornell Medicine, Cornell University, New York, NY, United States
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