Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic

Cross sectional associations of physical activity and sleep with mental health among Chinese university students

OBJECTIVE

This study aimed to examine the levels of physical activity (PA), sleep, and mental health (MH), specifically depression, anxiety, and stress, among Chinese university students. It also aimed to analyze the influencing factors of MH, providing a theoretical foundation for developing intervention programs to improve college students' mental health.

METHODS

A stratified, clustered, and phased sampling method was employed. In September 2022, a survey was conducted among 36,756 university students from 104 higher education institutions across 31 provinces, autonomous regions, and municipalities in China. The participants' PA behaviors, sleep patterns, depressive symptoms (use the CES-D), anxiety symptoms (use the GAD-7), smoking and drinking behaviors, and demographic information were assessed through an online questionnaire using Questionnaire Star software.

RESULTS

A total of 30,475 valid questionnaires were completed. The proportion of university students engaging in light-intensity PA was 77.6%. The prevalence of insufficient sleep was 39.5%, whereas the prevalence of poor sleep quality was 16.7%. The prevalence of depressive symptoms was 10%, and the prevalence of anxiety symptoms was 23.3%. Binary logistic regression analysis revealed that engaging in moderate to high-intensity PA and having sufficient and high-quality sleep were associated with a lower likelihood of depressive symptoms (OR = 0.207-0.800, P < 0.01), whereas appropriate sleep duration and higher sleep quality were associated with a lower likelihood of anxiety symptoms (OR = 0.134-0.827, P < 0.001).

CONCLUSION

The intensity of PA among university students is predominantly light, and the reported rate of insufficient sleep is relatively high. Moderate to high-intensity PA and sufficient high-quality sleep may alleviate MH issues among college students, with an interaction effect observed among PA, sleep, and depression symptoms. Future studies should further explore targeted interventions combining PA and sleep behaviors to enhance the MH of university students.

Association of 24-h movement behaviors during Covid-19 pandemic with spinal musculoskeletal disorders in undergraduate students: a cross-sectional study

Background and Aims

Musculoskeletal disorders (MSD) are an important health problem, and the Covid-19 pandemic affected several lifestyle and health aspects worldwide, including moderate-to-vigorous physical activity (MVPA), sedentary behavior (SB) and sleep time, which compose the 24-h movement guidelines (24-hMG). It is unclear whether meeting 24-hMG during pandemic have been associated with MSD in adult population and this study aimed to analyze the association of meeting 24-hMG with spinal MSD in undergraduate students during Covid-19 pandemic.

Methods

A sample of 71 undergraduate students were assessed (24.0 ± 6.6 years, 52% of women). MVPA was assessed by accelerometer, while daily time of SB and sleep were assessed by questionnaires. Spinal MSD was assessed by the Nordic questionnaire. Logistic regression models analyzed the association of meeting 24-hMG (individually and combined) with MSD, independently of age, sex, and body mass index.

Results

Spinal MSD affected 78.9% of sample. Only 11.3% of sample fully met the 24-hMG. Participants who did not meet both MVPA and SB guidelines were more likely to have MSD in low back (OR:3.45, p = 0.049) and spine (OR:3.78, p = 0.048) even after multiple adjustment. Otherwise, not meeting SB guideline was inversely associated with upper back MSD (OR:0.22, p = 0.012).

Conclusion

Meeting 24-hMG during Covid-19 pandemic were differently associated with spinal MSD, where combination of MVPA and SB shows to be protective against MSD in low back and in spine. However, the determinants of association between meeting SB guideline and higher upper back MSD still needs to be investigated.

Reallocating time between movement behaviors has implications for post-secondary students' mental health and wellbeing

Objective: Examine the theoretical impact of reallocating time between self-reported moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep on psychological distress and mental wellbeing among post-secondary students. Participants: 24,742 post-secondary students (Mage=24.3 ± 7.72 SD years; 66.4% women) from Cycle 1 of the Canadian Campus Wellbeing Survey. Methods: Cross-sectional isotemporal substitution modeling. Results: Replacing 20 min of screen time with either sleep or MVPA was associated with lower psychological distress, greater mental wellbeing, lower odds of reporting mild-to-severe psychological distress and low mental wellbeing, except for reallocating screen time to sleep among students who exceed the sleep guideline recommendations. Reallocating time between sleep and MVPA revealed noteworthy patterns: replacing sleep with MVPA was associated with greater mental wellbeing but not lower psychological distress. Conclusions: Findings highlight the potential mental health benefits of replacing screen time with sleep or MVPA as an integrative whole day approach to promote campus wellness.

Unhealthy Lifestyle Contributes to Negative Mental Health and Poor Quality of Life in Young University Students

Background: A negative lifestyle is reported to be related to poor mental health and quality of life (QOL). However, there is little information on this in university students. The objective of the present study was to investigate the association between mental health (i.e., anxiety, depression symptoms and stress), QOL, SWLS and lifestyle parameters (i.e., PA, sleep duration, ST and food habits) among Chilean university students and then to determine the differences in mental health, QOL, SWLS and lifestyle parameters according to gender. Methods: This cross-sectional study included a total of 211 university students (128 females and 83 males) aged 18-28 years. Mental health, QOL and lifestyle were measured through validated questionnaires. Results: Bad food habits (lowest score in the food survey) were linked to anxiety (2.3 [0.22-4.36], p = 0.03), depressive symptoms (3.75 [1.54-5.9], p = 0.001) and stress (2.24 [0.31-4.17], p = 0.023). Furthermore, <6 h of sleep was related to poorer mental health (13.5 [7.6-19.5], p = 0.001), anxiety (4.2 [2.0-6.4], p < 0.001), depressive symptoms (5.5 [3.2-7.9], p < 0.001) and stress (3.8 [1.8-5.9], p < 0.001). In addition, ≥4 h of ST was linked positively to negative mental health (8.3 [2.86-13.7], p = 0.003), depressive symptoms (3.45 [1.47-5.4], p = 0.001) and anxiety (3.2 [1.05-5.4], p = 0.004). Non-physical activity was related to the scores for anxiety (2.6 [0.20-5.0], p = 0.030), depression (2.7 [0.009-5.3], p = 0.049) and stress (2.4 [0.12-4.7], p = 0.039). Conclusions: this study showed that unhealthy lifestyle factors (i.e., insufficient sleep, lack of PA and prolonged ST) were strongly associated with poorer mental health and QOL in university students. These findings highlight the importance of addressing these aspects of lifestyle in intervention and health promotion programs aimed at young university students in order to improve their mental health and overall QOL.

Move more today, sleep better tonight? Daily associations between physical activity and sedentary behavior with sleep among young adults with and without insomnia symptoms

OBJECTIVE

At the between-person level, it is well-documented that individuals with more physical activity (PA) and less sedentary behavior (SB) tend to have better sleep outcomes than their peers. However, the associations at the within-person level remain unclear. This study investigated the daily associations between PA and SB with nighttime sleep among young adults with and without insomnia symptoms.

METHODS

Data was collected through activity trackers and online questionnaires for 7 consecutive days among 147 university students, including time spent on moderate to vigorous physical activity (MVPA), light physical activity (LPA), and SB, along with sleep duration, sleep efficiency, and sleep quality. Participants were classified into two subgroups according to the presence of insomnia symptoms, which were determined by a self-reported insomnia scale. Multilevel compositional data analysis was conducted on the total sample, and separately on subsamples characterized by the presence and absence of insomnia symptoms.

RESULTS

In the total sample and subsample without insomnia symptoms, substitutions among MVPA, LPA, and SB were not associated with changes in sleep outcomes at the daily level. However, in the subsample with insomnia symptoms, days with more MVPA or SB and less LPA were associated with higher sleep efficiency, while days with more LPA at the expense of MVPA or SB were associated with lower sleep efficiency.

CONCLUSIONS

For young adults with insomnia symptoms, replacing LPA with MVPA on a given day may improve their sleep efficiency that night.

Association of 24-hour movement guideline adherence, mental health and quality of life in young adults: the role of e-Health literacy

Background

The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.

Objective

This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.

Methods

1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.

Results

Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.

Conclusion

This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

Associations between 24-h movement behaviors and indicators of mental health and well-being across the lifespan: a systematic review

Researchers have adopted a variety of analytical techniques to examine the collective influence of 24-h movement behaviors (i.e., physical activity, sedentary behaviors, sleep) on mental health, but efforts to synthesize this growing body of literature have been limited to studies of children and youth. This systematic review investigated how combinations of 24-h movement behaviors relate to indicators of mental ill-being and well-being across the lifespan. A systematic search of MEDLINE, PsycINFO, Embase, and SPORTDiscus was conducted. Studies were included if they reported all three movement behaviors; an indicator of mental ill-being or well-being; and were published in English after January 2009. Samples of both clinical and non-clinical populations were included. A total of 73 studies (n = 58 cross-sectional; n = 15 longitudinal) met our inclusion criteria, of which 47 investigated children/youth and 26 investigated adults. Seven analytical approaches were used: guideline adherence (total and specific combinations), movement compositions, isotemporal substitution, profile/cluster analyses, the Goldilocks method and rest-activity rhythmicity. More associations were reported for indicators of mental ill-being (n = 127 for children/youth; n = 53 for adults) than well-being (n = 54 for children/youth; n = 26 for adults). Across the lifespan, favorable benefits were most consistently observed for indicators of mental well-being and ill-being when all three components of the 24-h movement guidelines were met. Movement compositions were more often associated with indicators of mental health for children and youth than adults. Beneficial associations were consistently observed for indicators of mental health when sedentary behavior was replaced with sleep or physical activity. Other analytic approaches indicated that engaging in healthier and more consistent patterns of movement behaviors (emphasizing adequate sleep, maximizing physical activity, minimizing sedentary behaviors) were associated with better mental health. Favorable associations were reported less often in longitudinal studies. Collectively, these findings provide further support for adopting an integrative whole day approach to promote mental well-being and prevent and manage mental ill-being over the status quo of focusing on these behaviors in isolation. This literature, however, is still emerging-for adults in particular-and more longitudinal work is required to make stronger inferences.

The Longitudinal Features of Depressive Symptoms During the COVID-19 Pandemic Among Chinese College Students: A Network Perspective

There is substantial evidence that the Corona Virus Disease 2019 (COVID-19) pandemic increased the risk of depressive symptoms among college students, but the long-term features of depressive symptoms on a symptom level have been poorly described. The current study investigated interaction patterns between depressive symptoms via network analysis. In this longitudinal study, participants included 860 Chinese college students (65.8% female; M_age = 20.6, SD_age = 1.8, range: 17-27) who completed a questionnaire at three-time points three months apart. Results demonstrated that fatigue was the most influential symptom, and the occurrence of fatigue could give rise to other depressive symptoms. In addition to predicting other symptoms, fatigue could be predicted by other symptoms in the measurement. The network structures were similar across time, suggesting that the overall interaction pattern of depressive symptoms was stable over the longitudinal course. These findings suggest that depressive symptoms during the COVID-19 period are associated with the presence of fatigue.

Bidirectional associations of physical activity, sleep, and self-reported mental health in young adults participating in an online wellness intervention during the COVID-19 pandemic

Purpose

The purpose of this study was to examine the bidirectional associations of physical activity (PA), sleep, and mental health in young adults participating in an online wellness intervention from October 2021 to April 2022.

Methods

Participants were a sample of undergraduate students from one US university (N = 89; 28.0% freshman; 73.0% female). The intervention was a 1-h health coaching session that was delivered either once or twice by peer health coaches on Zoom during COVID-19. The number of coaching sessions was determined by random allocation of participants to experimental groups. Lifestyle and mental health assessments were collected at two separate assessment timepoints after each session. PA was assessed using the International Physical Activity Questionnaire-Short Form. Weekday and weekend sleep were assessed by two one-item questionnaires and mental health was calculated from five items. Cross-lagged panel models (CLPMs) examined the crude bidirectional associations of PA, sleep, and mental health across four-time waves (i.e., T1 through T4). To control for individual unit effects and time-invariant covariates, linear dynamic panel-data estimation using maximum likelihood and structural equation modeling (ML-SEM) was also employed.

Results

ML-SEMs showed that mental health predicted future weekday sleep (β = 0.46, p < 0.001) and weekend sleep predicted future mental health (β = 0.11, p = 0.028). Although CLPMs showed significant associations between T2 PA and T3 mental health (β = 0.27, p = 0.002), no associations were observed when unit effects and time-invariant covariates were accounted for.

Conclusion

Self-reported mental health was a positive predictor of weekday sleep and weekend sleep positively predicted mental health during the online wellness intervention.

Development of a ParticipACTION App-Based Intervention for Improving Postsecondary Students' 24-Hour Movement Guideline Behaviors: Protocol for the Application of Intervention Mapping

BACKGROUND

The Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students' movement behaviors.

OBJECTIVE

We aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students.

METHODS

The Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app-based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses.

RESULTS

Participant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023.

CONCLUSIONS

Intervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app-based intervention targeting postsecondary students' movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app-based interventions. Should the forthcoming evaluation demonstrate the intervention's acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students' movement behaviors and mental well-being.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/39977.

Impact of COVID-19 pandemic on sleep of undergraduate students: A systematic literature review

The 2019 coronavirus pandemic forced the shift to distance education aggravating mental and physical vulnerabilities of undergraduate students, including sleep. This review aims to describe sleep problem rates and prevalence, sleep pattern disruption, sleep duration, sleep quality, insomnia symptoms, psychological and socio-economic factors affecting sleep of undergraduates in 22 countries. A systematic search for articles published from 2020 to 2021 using 'COVID-19,' 'Coronavirus,' 'Pandemic,' 'Sleep,' 'Mental Health,' and 'Students' from PubMed, Scopus, and Cochrane yielded 2550 articles, where 72 were included. Selection criteria were: English full-text available articles, undergraduates and not postgraduates, reported sleep outcomes, and participants not from allied health courses. Risk of bias was assessed using various Joanna Briggs Institute checklists and outcomes were descriptively synthesized. Prevalence of sleep problems was notable, while longitudinal studies showed increased rates. There was significantly increased sleep duration, and sleep pattern disruption during lockdowns. Several psychological, behavioural, environmental, demographic, and socio-economic factors were found to be associated with sleep changes. These highlight the pandemic's impact on sleep of undergraduate students and reveal opportunities for institutions to intervene with policies and programs to promote the well-being of undergraduates. Limitations include recall bias and underrepresentation of other countries. This study is self-funded with registration number RGAO-2021-0071.

Healthier movement behavior profiles are associated with higher psychological wellbeing among emerging adults attending post-secondary education

BACKGROUND

Emerging adulthood is a stressful time fraught with new challenges while attending higher education. Identifying protective factors to help reduce the psychological burden that many will experience during this period is therefore important. This study aimed to identify whether emerging adults attending post-secondary education can be classified into distinct profiles based on their 24-h movement behaviors, evaluate correlates of profile membership, and examine relationships between profile membership and indicators of mental health.

METHODS

This cross-sectional study used data from Cycle 1 of the Canadian Campus Wellbeing Survey. Emerging adults (N = 15,080; 67.6 % female; mean age = 20.78 ± 2.00) from 20 post-secondary institutions in Canada self-reported their movement behaviors - moderate-to-vigorous physical activity (MVPA), recreational screen time (ST) and sleep - and completed measures of psychological distress and mental wellbeing. Latent profile analysis was employed.

RESULTS

Five profiles were identified: low ST with very high (12.6 %), high (24.4 %) and low MVPA (51.2 %) as well as high ST with high (2.3 %) and low MVPA (9.4 %). Profiles had similar sleep patterns and were thus characterized by differences in MVPA and ST. Several socio-demographic variables were associated with profile membership. Profiles characterized by healthier combinations of MVPA, ST and sleep generally reported more favorable scores for indicators of mental health.

LIMITATIONS

Cross-sectional data limits causal inference, whereas self-reports may be biased.

CONCLUSIONS

Campus-based interventions should focus on getting students to engage in a healthy balance of physical activity and recreational screen use as it has the potential to reduce the mental health burden on emerging adults attending post-secondary education.

The Associations between Meeting 24-Hour Movement Guidelines (24-HMG) and Self-Rated Physical and Mental Health in Older Adults-Cross Sectional Evidence from China

BACKGROUND

This study determined the prevalence of older adults (aged 60-80 years) meeting the Canadian 24-HMG alone and in combination, and their association with the self-rated physical health and mental health of older adults.

METHODS

Participants were drawn from 4134 older adults aged 60-80 years (age, 67.37 ± 0.08 years; 46.87% male) from the China Health and Nutrition Survey (CHNS) 2015 database. Mental health and physical health scores were obtained based on self-rated mental health questionnaires and physical health of older adults. The criteria for meeting the 24-HMG were: physical activity time ≥ 150 min/week, sedentary time ≤ 480 min/day, screen time ≤ 180 min/day, sleep time 7-9 h (60-64 years) and sleep time 7-8 h (65 years and above). Logistic regression models were used to examine the association between meeting the 24-HMG guidelines number and category and older adults' self-rated mental and physical health.

RESULTS

The proportion of older people meeting three of the 24-HMG guidelines was 1.16%, the proportion meeting two guidelines was 38.19% and the proportion meeting one guideline was 49.14%. The number of people meeting 24-HMG was closely related to the self-rated physical health and mental health of older people. The category meeting 24-HMG was closely related to the self-rated physical health and mental health of older people.

CONCLUSIONS

Meeting more guidelines in the 24-HMG was strongly associated with older people's self-rated mental health and physical health. However, only a small proportion of older people met all the recommendations, highlighting the need to promote and support adherence to these movement behaviours.

Chinese College Students' Physical-Exercise Behavior, Negative Emotions, and Their Correlation during the COVID-19 Outbreak

BACKGROUND

In the period of the COVID-19 pandemic, the level of college students' physical exercise, the detection rate of negative emotions, and their correlation should attract extensive attention. Therefore, this study aimed to explore the correlation between college students' physical exercise and negative emotions.

METHODS

Data were collected via a web-based cross-sectional survey. A questionnaire survey was conducted among 3118 college students from five universities in Shanghai in March 2022. In addition to sociodemographic information, measures included Physical Activity Rating Scale (PARS-3) and Depression Anxiety Stress Scale (DASS). The chi-squared test and logistic regression were used to analyze the differences and test the relative risk of negative emotions caused by different amounts of physical exercise.

RESULTS

Most students (66.1%) performed a small amount of physical exercise. Male students' physical-exercise level was higher than female students', and the detection rate of negative emotions was lower than that of female students. Moderate and low physical-exercise levels were associated with a higher risk of depression (beta of 0.289 and 0.345, respectively) and anxiety (beta of 0.301 and 0.418) symptoms than high physical-exercise level.

CONCLUSIONS

The anxiety symptoms of college students were significant during the COVID-19 pandemic period. The physical-exercise behavior of college students was closely related to negative emotions, and the weakening of physical-exercise behavior was one of the factors that induced negative emotions in college students.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.