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Wang W, Chen B, Yang S. The impact of COVID-19 quarantine on college students' mental health. BMC Public Health 2025; 25:1665. [PMID: 40329242 PMCID: PMC12054329 DOI: 10.1186/s12889-025-22669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 04/07/2025] [Indexed: 05/08/2025] Open
Abstract
BACKGROUND The COVID-19 pandemic is a global public health crisis. The quarantine measures for COVID-19 have caused harm to the mental health of college students, and it is of great significance to continue focusing on the impact of COVID-19 on mental health. METHODS The data comes from the research group on the impact of COVID-19 on college students' mental health. A total of 2,033 Chinese college students participated in this study, including 1,285 female and 748 male students, with an average age of 19.81 years (SD = 1.22). Using the ordered logistic regression model, the study analyzed the mechanisms of academic stress, employment pressure, and sleep quality to investigate the impact of COVID-19 quarantine on college students' mental health. RESULTS Quarantine due to the COVID-19 pandemic has a significant impact on college students' mental health. The impact of quarantine on college students' mental health is economically stratified, with lower family income students experiencing greater effects and higher family income students experiencing lesser effects. Academic stress, employment pressure, and sleep quality are important mechanisms through which quarantine affects college students' mental health. CONCLUSION This study provides new insights into the relationship between quarantine and mental health among college students during the COVID-19 pandemic, helping to offer targeted interventions for college students' mental health.
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Affiliation(s)
- Weiwei Wang
- Internal Medicine Department, The Third People's Hospital of Bengbu, No. 38, Shengli Middle Road, Bengbu City, Anhui, P. R. of China
| | - Baoling Chen
- School of Finance and Public Administration, Anhui University of Finance & Economics, #962 Caoshan Road, Bengbu City, Anhui, P. R. of China.
- School of Management, Hefei University of Technology, 193 Tunxi Rd, Hefei City, Anhui, P. R. of China.
| | - Shanlin Yang
- School of Management, Hefei University of Technology, 193 Tunxi Rd, Hefei City, Anhui, P. R. of China
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Bianchi D, Di Tata D, Di Norcia A, Pompili S, Fatta LM, Laghi F. Binge eating as an emotional response to the COVID-19 pandemic: a sequential mediation model via the impact of events and social anxiety. J Eat Disord 2024; 12:209. [PMID: 39716336 DOI: 10.1186/s40337-024-01182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 12/13/2024] [Indexed: 12/25/2024] Open
Abstract
BACKGROUND The long-lasting consequences of the COVID-19 pandemic on the psychological well-being of young people have become an emerging research topic, which still raises several questions for post-pandemic interventions at the individual and community levels. This research investigated the relationship between COVID-19 pandemic life events and the occurrence of binge eating behaviors in emerging adults, hypothesizing indirect effects of the emotional impact of pandemic events and social anxiety. METHODS Data collection was conducted in November and December 2021 in Italy, involving 286 university students aged 18 to 30 years (Mage = 20.20; SDage = 2.43; 69.6% women) who completed an online anonymous survey. Participants reported the pandemic-related stressors experienced in the last year (i.e., adverse life events; the number of days in quarantine), the long-lasting emotional impact of these experiences in the previous week (i.e., intrusive thoughts; avoidance of thoughts), social anxiety symptoms, and frequency of binge eating episodes. A serial mediation model was tested in line with the research hypotheses. RESULTS Both the number of days in quarantine and the pandemic adverse life events in the last year were significantly and positively related to binge eating via the sequential indirect effects of (1) intrusive thoughts and (2) social anxiety. CONCLUSION Our findings provide support for the long-lasting effects of pandemic events and quarantine on emerging adults' mental health, with cascade effects on intrusive symptoms, social anxiety, and binge eating. The study has interesting research, practice, and public health policies implications.
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Affiliation(s)
- Dora Bianchi
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, Rome, 00185, Italy.
| | - Daniele Di Tata
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, Rome, 00185, Italy
| | - Anna Di Norcia
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, Rome, 00185, Italy
| | - Sara Pompili
- University of International Studies of Rome, Rome, Italy
| | | | - Fiorenzo Laghi
- Department of Social and Developmental Psychology, University of Rome Sapienza, via dei Marsi 78, Rome, 00185, Italy
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Li G, Sun X, Gao T, Liang K, Wu M, Zhu Y, Gao X, Li P, Kong Y, Shu J. Analysis of risk factors and construction of a prediction model for posttraumatic stress disorder among Chinese college students during the COVID-19 pandemic. J Affect Disord 2024; 362:230-236. [PMID: 38969024 DOI: 10.1016/j.jad.2024.06.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/31/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND To explore the risk factors of post-traumatic stress disorder (PTSD) among Chinese college students during the COVID-19 pandemic and the construction and validation of risk prediction models. METHODS A total of 10,705 university students were selected for the study. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), PTSD Checklist for DSM-5 (PCL-5), and self-designed questionnaire. These assessments were conducted to facilitate the survey, construct the predictive model and validate the model's validity. RESULTS Sex, left-behind experience, poverty status, anxiety score, and depression score were identified as independent risk factors influencing psychological trauma among Chinese college students during the COVID-19 pandemic, while COVID-19 infection emerged as a protective factor against psychological trauma. A column chart was constructed to visualize the six independent risk factors derived from logistic regression analysis. The Hosmer-Lemeshow test results (χ2 = 13.021, P = 0.111) indicated that the risk prediction model fitted well. The receiver operating characteristic (ROC) curve showed an area under the curve (AUC) of 0.864 in the model group and 0.855 in the validation group. The calibration curves of the model closely resembled the ideal curve. Decision curve analysis (DCA) revealed that the model provided net benefit and demonstrated good clinical utility. LIMITATIONS The validation of the model is currently restricted to internal assessments. However, further confirmation through larger sample sizes, multicenter investigations, and prospective studies is necessary. CONCLUSIONS The model effectively predicted PTSD risk among Chinese college students during the COVID-19 pandemic, indicating strong clinical applicability.
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Affiliation(s)
- Guangjian Li
- Psychiatry and Psychology Department, Changzhou Dean Hospital, Changzhou, Jiangsu Province, China
| | - Xugui Sun
- Physical Education Teaching and Research Office, Wannan Medical College, Wuhu, Anhui Province, China
| | - Tingye Gao
- Psychiatry and Psychology Department, Changzhou Dean Hospital, Changzhou, Jiangsu Province, China.
| | - Kun Liang
- Graduate School, Wannan Medical College, Wuhu, Anhui Province, China
| | - Mengying Wu
- Pharmacy Department, The Second People's Hospital of Wuhu City, Wuhu, Anhui Province, China
| | - Yingzhi Zhu
- Psychiatry and Psychology Department, Changzhou Dean Hospital, Changzhou, Jiangsu Province, China
| | - Xin Gao
- Mental Health Education Center, ChangZhou Vocational Institute of Engineering, Changzhou, Jiangsu Province, China
| | - Peng Li
- Department of Student Affairs, ChangZhou Vocational Institute of Textile and Garment, Changzhou, Jiangsu Province, China
| | - Yaping Kong
- Psychiatry and Psychology Department, Changzhou Dean Hospital, Changzhou, Jiangsu Province, China
| | - Jingping Shu
- Psychiatry and Psychology Department, Changzhou Dean Hospital, Changzhou, Jiangsu Province, China.
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Yang Q, Xie J, Li Z, Zhai C, Sheng M, Li S, Gao M. Association between sleep quality, depressive symptoms, and suicidal ideation in college students. PSYCHOL HEALTH MED 2024; 29:1583-1601. [PMID: 38503424 DOI: 10.1080/13548506.2024.2331491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
Suicide among college students is a challenging problem globally. Yet, the association between sleep quality, depressive symptoms, and suicidal ideation remains unclear. This study aims to understand if depressive symptoms mediate the relationship between sleep quality and suicide ideation and whether the interaction between depressive symptoms and sleep quality on suicidal ideation is additive. A total of 1182 college students were recruited, and sleep quality, depressive symptoms, and suicidal ideation were assessed using questionnaires. Univariate analysis, logistic regression analysis, linear regression models, and the Sobel test were performed. The results showed that, among college students, poor sleep quality was positively associated with suicidal ideation, and the association was mediated through depressive symptoms. Moreover, there was a significant additive interaction between poor sleep quality and depressive symptoms on suicidal ideation. These findings suggest that, in the process of preventing and treating suicidal ideation in college students with sleep disorders, we should focus on the evaluation and intervention of depressive symptoms and adopt multidisciplinary team interventions for college students with sleep disorders and depression.
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Affiliation(s)
- Qianqian Yang
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Jiafan Xie
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Zehan Li
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Chenxiao Zhai
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Meiyan Sheng
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Shengpeng Li
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
| | - Mengqian Gao
- Medical School, Liaocheng University, Liaocheng, Shandong Province, P.R. China
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Chen Y, Ke X, Liu J, Du J, Zhang J, Jiang X, Zhou T, Xiao X. Trends and factors influencing the mental health of college students in the post-pandemic: four consecutive cross-sectional surveys. Front Psychol 2024; 15:1387983. [PMID: 39086428 PMCID: PMC11288898 DOI: 10.3389/fpsyg.2024.1387983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024] Open
Abstract
Background The long-term impact of COVID-19 on the mental health and well-being of college students, specifically trends over time after full removal of COVID-19 restrictions, has not been well-studied. Methods Four consecutive cross-sectional surveys were conducted in December 2022 (N = 689), March 2023 (N = 456), June 2023 (N = 300), and November 2023 (N = 601) at a university in Sichuan Province, China. Results The proportion of students with COVID-19 panic decreased from 95.1 to 77.3% (p < 0.001). The prevalence of moderate anxiety and above decreased from 18 to 13.6% (p < 0.001), and the prevalence of moderate and above depression decreased from 33.1 to 28.1% (p < 0.001), while the prevalence of post-traumatic stress disorder (PTSD) increased from 21.5 to 29.6% (p < 0.005). Further, the proportion of suicidal thoughts increased from 7.7 to 14.8% (p < 0.001). Suicidal thoughts and self-injuries were significantly associated with COVID-19 panic, depression, anxiety, and PTSD. Students who reported being in close contact with COVID-19 patients in the past were more likely to develop PTSD. Further, COVID-19-induced panic was a risk factor for self-injury. Conclusion One year after the COVID-19 pandemic, the overall mental health of college students was not optimal. Hence, we can conclude that the long-term impacts of COVID-19 on the mental health of college students may have already occurred. To mitigate this impact and prepare for the next major public health event, strengthening college students' mental health curricula and promoting healthy behaviors among college students should be a priority for universities and education authorities.
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Affiliation(s)
- Yinhai Chen
- Primary Health Care Research Centre, North Sichuan Medical College, Nanchong, China
| | - Xiong Ke
- Primary Health Care Research Centre, North Sichuan Medical College, Nanchong, China
| | | | - Jun Du
- Department of Foreign Languages and Cultures, North Sichuan Medical College, Nanchong, China
| | - Jiali Zhang
- Primary Health Care Research Centre, North Sichuan Medical College, Nanchong, China
| | - Xuan Jiang
- Primary Health Care Research Centre, North Sichuan Medical College, Nanchong, China
| | - Tong Zhou
- North Sichuan Medical College, Nanchong, China
| | - Xiao Xiao
- Central People’s Hospital of Zhanjiang, Zhanjiang, China
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Lai YJ, Tsai EY, Jarustanaput P, Wu YS, Chen YH, O’Leary SE, Manachevakul S, Zhang Y, Shen J, Wang Y. Optimism and mental health in college students: the mediating role of sleep quality and stress. Front Psychol 2024; 15:1403146. [PMID: 39081373 PMCID: PMC11286569 DOI: 10.3389/fpsyg.2024.1403146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/25/2024] [Indexed: 08/02/2024] Open
Abstract
Objective College students showed a high prevalence of stress, anxiety, and depression, with medical and nursing students experiencing particularly elevated levels of mental health challenges.Optimism significantly influences overall well-being by promoting a healthy lifestyle and cognitive responses. However, the association of optimism with sleep quality, stress, and mental health in college students remains unexplored. This study aimed to (1) explore the associations of optimism with sleep quality, stress, and mental health and (2) ascertain whether sleep quality and stress mediate the association between optimism and mental health among college students. Methods A cross-sectional study was conducted using online surveys with students from health science majors at a public university in the northeast United States from September to December 2022. A total of 222 students participated in the study, providing data on sociodemographics, optimism, sleep quality, stress, anxiety, and depression. Parallel and serial mediation models were utilized to examine the potential mediating roles of sleep quality and stress in the association between optimism and mental health. Results The study found that optimism influences anxiety and depression through both direct and indirect pathways. In line with predictions, the parallel mediation analysis revealed that the impact of optimism on anxiety (βtotal = -0.598, 95% confident interval [CI]: -0.778 to -0.392) and depression (βtotal = -0.724, 95% CI: -0.919 to -0.519) was mediated by stress and sleep quality. Furthermore, the serial mediation models revealed that stress and sleep quality co-mediated the relationship betweenoptimism and anxiety (indirect effect [IE] = -0.074, 95% CI: -0.135 to -0.029) or depression (IE = -0.084, 95% CI: -0.142 to -0.036) in a sequential manner. Conclusion Optimism was negatively correlated with poor sleep quality, stress, anxiety, and depression. Enhanced optimism was linked to high sleep quality and less stress, anxiety, and depression. These insights emphasize the potential for school-based optimism interventions to improve sleep quality, ameliorate stress-related concerns, and alleviate mental health challenges in college students.
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Affiliation(s)
- Yun-Ju Lai
- School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - En-Yun Tsai
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ploypapus Jarustanaput
- School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Yi-Syuan Wu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Yi-Hau Chen
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Samantha E. O’Leary
- School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Sumatchara Manachevakul
- School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Yuan Zhang
- School of Nursing, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Jiabin Shen
- Department of Psychology, College of Fine Arts, Humanities & Social Sciences, University of Massachusetts Lowell, Lowell, MA, United States
| | - Yan Wang
- Department of Psychology, College of Fine Arts, Humanities & Social Sciences, University of Massachusetts Lowell, Lowell, MA, United States
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Ning X, Luo X, Guo S. Researching into Chinese university students' mental health in the post-pandemic era - problems and causes. Front Psychol 2024; 15:1393603. [PMID: 38984286 PMCID: PMC11231423 DOI: 10.3389/fpsyg.2024.1393603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/13/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Mental health challenges have still been widely pervasive among Chinese university students after the outbreak of the COVID-19 pandemic. This article aims to explore mental health challenges encountered by Chinese university students in the post-pandemic era and explain causes to these challenges using a qualitative approach. Methods We conducted six focus group interviews with university students in Zhuhai, China, and altogether 61 students including 43 female students, and 18 male students participated in the study. Results Our results indicate that sleep difficulties, anxiety, and stress are the three primary mental health challenges experienced by students. Academic pressure, social influence including peer pressure and pursuit of social acceptance, and pandemic related policies and measures are the causes to the above mental health challenges. Discussion The results of this study will inform the development of mental health promotion, intervention, and education activities for university students to bolster their resilience and cope with mental health problems in the post-pandemic era. Meanwhile, our results could illuminate the services stakeholders provide to university students in the future.
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Affiliation(s)
- Xuan Ning
- Beijing Normal University-Hong Kong Baptist University United International College, Zhuhai, China
| | - Xiaoyu Luo
- Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Sijia Guo
- Dalian Maritime University, Dalian, China
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Yao L, Liang K, Huang L, Chi X. Relationship between fruit and vegetable consumption and internet addiction with insomnia and depression as multiple mediators during the COVID-19 pandemic: a three-wave longitudinal study in Chinese college students. BMC Psychiatry 2023; 23:939. [PMID: 38093234 PMCID: PMC10720225 DOI: 10.1186/s12888-023-05415-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The relationships between fruit and vegetable consumption (FV) and Internet addiction (IA) in college students still remained unknown together with the internal mechanisms. Given the limitations of previous cross-sectional design, longitudinal research was necessary to be conducted to explore more precise correlations. Using the three-wave data in a longitudinal design, this study aimed to explore the association between FV and IA among Chinese college students and potential multiple mediators of insomnia and depression during the COVID-19 pandemic. METHODS A total of 579 college students were recruited during three waves (T1: August 2020; T2: November 2020; T3: February 2021). FV (T1), insomnia (T2), depression (T2) and IA (T3) symptoms were reported. The descriptive statistics of the sociodemographic characteristics and correlation analyses of the study variables were calculated. The significance of the mediation effects was measured conducting a bootstrap method with SPSS PROCESS macro. RESULTS FV was negatively correlated with IA, and lower FV predicted higher risk of IA. Depression mediated the association between FV and subsequent IA. Insomnia and depression were multiple mediators, which in turn mediated the links between FV and subsequent IA. CONCLUSIONS The three-wave longitudinal study has revealed that FV had indirect effects on IA through individual mediating factor of depression and multiple mediating roles of insomnia and depression sequentially. The policy makers, educators and researchers should pay attention to the impact of the interventions from healthy diet, in order to optimize the coping strategies for preventing college students from IA.
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Affiliation(s)
- Liqing Yao
- School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
- Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Macau, China
| | - Kaixin Liang
- School of Psychology, Shenzhen University, Shenzhen, China
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen University, Shenzhen, China
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Liuyue Huang
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, China
| | - Xinli Chi
- School of Psychology, Shenzhen University, Shenzhen, China.
- The Shenzhen Humanities & Social Sciences Key Research Bases of the Center for Mental Health, Shenzhen University, Shenzhen, China.
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Valladares-Garrido D, Quiroga-Castañeda PP, Berrios-Villegas I, Zila-Velasque JP, Anchay-Zuloeta C, Chumán-Sánchez M, Vera-Ponce VJ, Pereira-Victorio CJ, Failoc-Rojas VE, Díaz-Vélez C, Valladares-Garrido MJ. Depression, anxiety, and stress in medical students in Peru: a cross-sectional study. Front Psychiatry 2023; 14:1268872. [PMID: 38090694 PMCID: PMC10715266 DOI: 10.3389/fpsyt.2023.1268872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/26/2023] [Indexed: 02/01/2024] Open
Abstract
Objective To determine the prevalence and factors associated with depressive, anxious, and stress symptoms in medical students in Peru, during the second pandemic wave of COVID-19. Methods We conducted an analytical cross-sectional study in 405 medical students from a university in northern Peru. The DASS-21 instrument was used to evaluate mental health outcomes (depression, anxiety, and stress), and to investigate their association with socio-educational characteristics. Results We found a prevalence of depressive, anxious, and stress symptoms of 71.6% (95% CI: 66.94-75.95), 71.9% (95% CI: 67.2-76.2), and 62.7% (95% CI: 57.8-67.4); respectively. Students with eating behavior disorders had a higher prevalence of depressive symptoms (PR: 1.35), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.31). The prevalence of depressive symptoms (PR: 1.57), anxious symptoms (PR: 1.27), and stress symptoms (PR: 1.24) increased in students who did not report regular physical activity. In addition, having almost always academic exhaustion increased the prevalence of depressive symptoms (PR: 1.46), stress symptoms (PR: 1.72). On the contrary, the prevalence of depressive symptoms (PR: 0.79), anxious symptoms (PR: 0.73) and stress symptoms (PR: 0.82) decreased in male students. Students who reported sleeping 8 or more hours daily had a lower prevalence of stress symptoms (PR: 0.82). Conclusion Symptoms of depression and anxiety occurred in 7 out of 10 students, and stress in 6 out of 10. Among the factors associated with the presence of anxiety, depression, and stress were eating behavior disorder and not regularly exercising. Periodic evaluations of mental symptomatology are required and counseling should be promoted in medical schools.
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Affiliation(s)
- Danai Valladares-Garrido
- Escuela de Medicina, Universidad Cesar Vallejo, Trujillo, Peru
- Oficina de Salud Ocupacional, Hospital de Apoyo II Santa Rosa, Piura, Peru
| | | | | | - J. Pierre Zila-Velasque
- Universidad Nacional Daniel Alcides Carrión, Facultad de Medicina Humana, Pasco, Peru
- Red Latinoamericana de Medicina en La Altitud e Investigación (REDLAMAI), Pasco, Peru
| | - Claudia Anchay-Zuloeta
- Facultad de Medicina, Universidad de San Martín de Porres, Chiclayo, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Marisella Chumán-Sánchez
- Facultad de Medicina, Universidad de San Martín de Porres, Chiclayo, Peru
- Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Víctor J. Vera-Ponce
- Instituto de Investigación en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Peru
- Universidad Tecnológica del Perú, Lima, Peru
| | | | - Virgilio E. Failoc-Rojas
- Unidad de Investigación para Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Cristian Díaz-Vélez
- Escuela de Medicina, Universidad Privada Antenor Orrego, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
| | - Mario J. Valladares-Garrido
- Facultad de Medicina, Universidad de San Martín de Porres, Chiclayo, Peru
- South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima, Peru
- Oficina de Epidemiología, Hospital Regional Lambayeque, Chiclayo, Peru
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Wang X, Zhang J, Yang N, Zou M, He P. Stress and influencing factors of public health and preventive medicine students in the post-pandemic period: a cross-sectional study in Changsha, China. Front Public Health 2023; 11:1227441. [PMID: 37588114 PMCID: PMC10427115 DOI: 10.3389/fpubh.2023.1227441] [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: 05/24/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Objectives Little is known about the stress levels and associated factors of public health and preventive medicine students in the post-pandemic period. This study aims to investigate the stress levels of these students in the post-COVID-19 era and to determine the association of personal background, employment attitude, and psychological state with stress. Methods A cross-sectional survey was conducted in March 2023 among 620 public health and preventive medicine students from two universities in Changsha, China. The survey included demographic characteristics, employment attitudes, perceived stress scale 10, general anxiety disorder 7, the University of California at Los Angeles loneliness scale 20, and the PTSD checklist-civilian version. Two-sided t-tests and ANOVA tests were used to compare the differences in PSS scores among variables, and multiple hierarchical regression analysis was used to evaluate the associated factors with stress. Results The survey was completed by 504 students (mean age: 21.5 ± 2.6 years, 69.2% female). 24.8% of the students were screened for a high level of stress. 69.0% thought the epidemic positively impacted employment while 18.5% believed it had a negative impact. The results of regression analysis showed that older age (B = 0.42, p = 0.001), higher grade (B 1 = 3.59, p < 0.001, B 2 = 4.57, p < 0.001), having internship experiences (B = 1.16, p = 0.006), having anti-epidemic experiences (B = 1.77, p < 0.001), believing that COVID-19 has a negative impact on employment (B = 2.56, p < 0.001), and having higher GAD scores (B = 0.64, p < 0.001) and UCLA scores (B = 0.07, p = 0.002) were significantly associated with high-stress levels. Conversely, being female (B = -1.64, p < 0.001) and believing that the pandemic had a positive impact on employment (B = -1.98, p = 0.001) were associated with low-stress levels. Conclusion Public health and preventive medicine students in Changsha, China, experienced a high-stress level in the post-pandemic period, which was influenced by age, gender, grade, employment attitude, internship experience, anxiety, and loneliness. As one of the main guardians of the epidemic, these students should be given more attention and psychological interventions in the future.
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Affiliation(s)
- Xiaofen Wang
- Department of Nursing, School of Medicine, Hunan Normal University, Changsha, China
| | - Jiahui Zhang
- Department of Nursing, School of Medicine, Hunan Normal University, Changsha, China
| | - Na Yang
- Department of Nursing, School of Medicine, Hunan Normal University, Changsha, China
| | - Miliang Zou
- Department of Oncology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Pingping He
- Department of Nursing, School of Medicine, Hunan Normal University, Changsha, China
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Cheng J, Liao M, He Z, Xiong R, Ju Y, Liu J, Liu B, Wu B, Zhang Y. Mental health and cognitive function among medical students after the COVID-19 pandemic in China. Front Public Health 2023; 11:1233975. [PMID: 37575102 PMCID: PMC10416241 DOI: 10.3389/fpubh.2023.1233975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Chinese people experienced a nationwide coronavirus disease 2019 (COVID-19) pandemic after the adjustment of epidemic response policies from December 2022 to January 2023. This study aims to explore the prevalence of mental and cognitive symptoms and their associated factors among medical students after the COVID-19 pandemic. Methods A cross-sectional study was conducted between February 27th and March 8th, 2023. The symptoms of anxiety, depression, insomnia, post-traumatic stress disorder (PTSD), and cognitive function among medical students were examined using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Athens Insomnia Scale (AIS), the Impact of Event Scale-6 (IES-6), and the Perceived Deficits Questionnaire-Depression-5 (PDQ-D-5). Data on demographic information was also collected. Statistical analyses were conducted to describe the prevalence and explore the associated factors of mental and cognitive symptoms. Results Among 947 participants, the proportion of students experiencing anxiety, depression, insomnia, and PTSD symptoms was 37.8, 39.3, 28.3, and 29.5%, respectively. The self-reported COVID-19 infection rate was 72.2%. Higher grades, childhood, and current rural residence were identified as potential risk factors for mental and cognitive symptoms. Gender, age, average monthly household income, and COVID-19 diagnosis were not associated with mental and cognitive symptoms among medical students. Conclusion Our findings revealed a high prevalence of mental and cognitive symptoms among Chinese medical students after the COVID-19 pandemic. Special attention should be paid to the mental health of higher-grade students and those residing in rural areas.
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Affiliation(s)
- Junzhe Cheng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Mei Liao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Ziping He
- Clinical Medicine Eight-Year Program, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Rui Xiong
- School of Stomatology, Nanchang University, Nanchang, Jiangxi, China
| | - Yumeng Ju
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Jin Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Bangshan Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
| | - Bei Wu
- Hospital Management Office, Central South University, Changsha, Hunan, China
| | - Yan Zhang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, China
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12
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Peng P, Wang Y, Li Z, Zhou Y, Wang J, Qu M, Liu T. A network analysis of the long-term quality of life and mental distress of COVID-19 survivors 1 year after hospital discharge. Front Public Health 2023; 11:1223429. [PMID: 37575111 PMCID: PMC10416228 DOI: 10.3389/fpubh.2023.1223429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives COVID-19 survivors suffer from persistent mental distress and impaired quality of life (QOL) after recovery from the infection. However, the symptom-symptom interaction between these psychological variables remained unexplored. The present study aimed to determine the symptom network of mental distress (depression, anxiety, sleep disturbance, fatigue, and post-traumatic stress disorder) and their association with QOL among 535 COVID-19 survivors 1 year after hospital discharge. Methods 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale, Chalder fatigue scale, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and 36-Item Short-Form Health Survey were applied to measure depression, anxiety, fatigue, PTSD, sleep disturbances, and QOL, respectively. Two networks were estimated using Gaussian graphical model. Network 1 consisted of mental symptoms to determine the central and bridge symptoms. Network 2 additionally included QOL to determine which mental symptoms were mostly related to QOL. Results 60% of the COVID-19 survivors experienced mental distress 1 year after hospital discharge. Uncontrollable and excessive worry, psychomotor symptoms, intrusion, and daytime dysfunction were the most central symptoms. Daytime dysfunction and fatigue (especially mental fatigue and loss of energy) served as the bridge symptoms across the mental distress network and exhibited the most substantial association with QOL. Conclusion Our study demonstrated several key symptoms that played a vital role in mental distress and QOL among COVID-19 survivors. Prompt screening and targeted interventions for these symptoms might hold great promise in preventing mental distress and improving QOL in COVID-19 survivors.
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Affiliation(s)
- Pu Peng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yaqi Wang
- College of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhuqing Li
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Yanan Zhou
- Department of Psychiatry, Hunan Brain Hospital (Hunan Second People’s Hospital), Changsha, China
| | - Ji Wang
- National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China
| | - Miao Qu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Tieqiao Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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13
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Chen H, Feng H, Liu Y, Wu S, Li H, Zhang G, Yang P, Zhang K. Anxiety, depression, insomnia, and PTSD among college students after optimizing the COVID-19 response in China. J Affect Disord 2023:S0165-0327(23)00717-6. [PMID: 37245554 DOI: 10.1016/j.jad.2023.05.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The number of COVID-19 infections has increased sharply and quickly after optimizing the COVID-19 response in China. In the context of this population-size infection, college students' psychological response is yet to be understood. METHODS A cross-sectional study was designed to investigate anxiety, depression, insomnia, and post-traumatic stress disorder (PTSD) symptoms among college students from December 31, 2022, to January 7, 2023. The questionnaire included the Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire 9 (PHQ-9), Insomnia Severity Index (ISI), Impact of Event Scale (IES-R), and self-designed questionnaire. RESULTS Of the 22,624 respondents, the self-reported prevalence of anxiety, depression, insomnia, PTSD, and any of the four psychological symptoms appeared as 12.7 %, 25.8 %, 11.6 %, 7.9 %, and 29.7 %, respectively. The self-reported COVID-19 infection rate was 80.2 %. Changes in the place for learning, longer time online, not recovering after infection, a higher proportion of family member infection, insufficient drug reserve, worry about sequela after infection, future studies, or employment contributed to a higher risk of anxiety/depression/insomnia symptoms or PTSD symptoms. Multinomial logistic regression showed that those who spent more extended time on the Internet, recovered after infection, and had insufficient drug reserves were less likely to have PTSD than anxiety/depression/insomnia symptoms. LIMITATIONS The study was a non-probability sampling survey. CONCLUSIONS Anxiety, depression, insomnia, and PTSD were common psychological symptoms among college students when infection went through a large-scale population. This study highlights the importance of continuing to care for the psychological symptoms of college students, especially timely responses to their concerns related to the epidemic situation and COVID-19 infection.
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Affiliation(s)
- Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Haolou Feng
- Hebei College of Science and Technology, Baoding 071000, China
| | - Yiyang Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Shaoshuai Wu
- Hebei College of Science and Technology, Baoding 071000, China
| | - Hui Li
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Guowei Zhang
- College of Chinese Medicine, Hebei University, Baoding 071000, China
| | - Peiyue Yang
- Hebei College of Science and Technology, Baoding 071000, China.
| | - Konglai Zhang
- Department of Epidemiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing 100005, China.
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14
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Quan L, Lu W, Zhen R, Zhou X. Post-traumatic stress disorders, anxiety, and depression in college students during the COVID-19 pandemic: a cross-sectional study. BMC Psychiatry 2023; 23:228. [PMID: 37016381 PMCID: PMC10072042 DOI: 10.1186/s12888-023-04660-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused an increase in psychiatric disorders in college students, particularly posttraumatic stress disorders (PTSD), depression, and anxiety. While existing studies assess the prevalence of these disorders and their predictors, they overlook potential complications caused by comorbidity between these disorders. To fill this gap, this study examined the prevalence of PTSD, depression, anxiety, and their comorbidity to inform targeted intervention for college students during the COVID-19 pandemic. DESIGN Self-report questionnaires were used to assess 6,898 college students about six months after the COVID-19 outbreak. RESULTS The results found that the prevalence of PTSD, depression, and anxiety were 15.5%, 32.2%, and 32.1% respectively, and the prevalence of comorbid PTSD and depression, comorbid PTSD and anxiety, comorbid depression and anxiety, and comorbid PTSD, depression, and anxiety symptoms were 11.5%, 11.6%, 20.4%, and 9.4% respectively. Moreover, left-behind status, lower economic status, previous trauma experiences, exposure to the pandemic, and rumination were risk factors of psychological distress, but self-disclosure was a protective factor for these disorders. CONCLUSION These results indicate that distinct psychiatric disorders may be comorbid in individuals, and are further influenced by pre-, within-, and post-disaster factors. Furthermore, psychological service targeted at college students should pay attention to comorbid symptoms rather than only symptoms of single disorders.
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Affiliation(s)
- Lijuan Quan
- School of Educational Science, Anhui Normal University, Wuhu, 241000, China
| | - Wei Lu
- School of Educational Science, Anhui Normal University, Wuhu, 241000, China
| | - Rui Zhen
- Jing Hengyi School of Education, Hangzhou Normal University, Hangzhou, 311121, China.
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, China
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15
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Suwannakul B, Sangkarit N, Manoy P, Amput P, Tapanya W. Association between Stress and Physical Fitness of University Students Post-COVID-19 Pandemic. J Funct Morphol Kinesiol 2023; 8:jfmk8010033. [PMID: 36976130 PMCID: PMC10052582 DOI: 10.3390/jfmk8010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/18/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Post-COVID-19 pandemic, most universities changed their educational model from online courses to onsite learning, allowing students to attend regular face-to-face classes. These changes can cause stress in students, which affects physical fitness. The aim of this study was to investigate the relationship between stress levels and physical fitness in female university students. The participants were 101 female university students, 18-23 years of age. All participants completed the Suan Prung Stress Test-60 (SPST-60). The physical fitness test included body composition, cardiorespiratory fitness, as well as musculoskeletal fitness. Multiple linear regression analysis was used to determine the associations between SPST-60 scores and physical fitness. A p-value < 0.05 was considered statistically significant. We found a negative correlation between the sources of stress scores, here environment, and maximal oxygen consumption (β = -0.291; 95% CI, -0.551, -0.031). We also found that symptoms of stress scores in the parasympathetic and sympathetic nervous systems were positively associated with waist-hip circumference ratio (WHR) (β = 0.010; 95% CI, 0.002, 0.017 and β = 0.006; 95% CI, 0.000, 0.012, respectively). Moreover, the symptoms of stress, here emotion, were positively associated with the WHR (β = 0.005; 95 %CI, 0.001, 0.009) and negatively associated with upper extremity muscle strength (β = -0.005; 95% CI, -0.009, 0.000). The results of this study confirmed the associations between stress levels in the post-COVID-19 pandemic era and WHR, maximal oxygen consumption, and upper extremity muscle strength. As a result, stress reduction or prevention alternatives should be considered in order to maintain physical fitness and prevent stress disorders.
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Affiliation(s)
- Boonsita Suwannakul
- Department of Physical Therapy, School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao 56000, Thailand
| | - Pacharee Manoy
- Department of Physical Therapy, School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
| | - Patchareeya Amput
- Department of Physical Therapy, School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao 56000, Thailand
| | - Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
- Unit of Excellence of Human Performance and Rehabilitations, University of Phayao, Phayao 56000, Thailand
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16
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Xu M, Tian R, Fu C, Li J, Bi D, Wang Y. The impact of family function on post-traumatic reactions of Chinese adolescents infected with COVID-19: a latent profile study. Front Public Health 2023; 11:1153820. [PMID: 37213623 PMCID: PMC10192572 DOI: 10.3389/fpubh.2023.1153820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Background Since the end of 2019, Corona Virus Disease 2019, also known as COVID-19, has broken out in various countries. However, the change of China's COVID-19 prevention and control policy and the sharp increase in the number of infected people are making the teenagers have post-traumatic reactions. Negative post-traumatic reactions include: post-traumatic stress disorder (PTSD), depression, anxiety. Positive post-traumatic reaction mainly refers to post-traumatic growth (PTG). The purpose of this study is to explore the post-traumatic reaction, which refers to PTSD, depression, anxiety and the co-occurrence pattern of growth after trauma and to further explore the influence of family function on different categories of Post-traumatic Reactions. Methods Latent profile analysis (LPA) was used to explore the co-occurrence of PTSD, depression, anxiety, and PTG. Multiple logistics regression was used to analyze the influence of family function on different categories of post-traumatic response. Results There were three categories of post-traumatic reactions in adolescents infected with COVID-19 adolescents infected with COVID-19, namely: growth class, struggling class, and pain class. Multivariate Logistic regression showed that the growth class and struggling class were affected by problem solving and behavior control in family function, while the growth class and pain class were affected by problem solving, roles, behavior control, and general functioning. Multiple logistic regression showed that the growth class and struggling class were affected by problem solving and roles. Conclusions The findings of this study provide evidence for the identification of high-risk individuals and the provision of effective interventions in clinical practice, as well as the influence of family functioning on the different categories of PTSD among adolescents infected with COVID-19.
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Affiliation(s)
- Mingtu Xu
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Runhui Tian
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
- *Correspondence: Runhui Tian
| | - Cong Fu
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Jingyang Li
- Department of Mental Health, First Affiliated Hospital of Jilin University, Changchun, China
| | - Dingyu Bi
- Department of Politics and Education, Jilin Experimental Middle School, Changchun, China
| | - Yan Wang
- Affiliated Middle School of Jilin University, Changchun, China
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