Positive Changes in Life Outcomes over the Pandemic in Chinese Adolescents: The Role of Resilience and Relation to Mental Health

Although the existing literature has well documented the negative effects of COVID-19 on multiple life outcomes in adolescents, research has also revealed that some life outcomes have become better during COVID-19. Scant research has specically examined to what and in what aspects COVID-19 is benecial to adolescent development so far. With person-centered approach, this research addressed this gap by: (1) exploring different proles of positive changes in life outcomes in Chinese adolescents since the outbreak of COVID-19; (2) examining the role of resilience in relation to different proles; (3) comparing mental health across adolescents categorized into different proles. 2 presents the raw score of each indicator of each prole and the results of MANOVA. We labelled the rst prole as “limited positive changes”. This prole consisted of 33.3% of participants. Participants in this prole showed positive changes in only a few aspects of life outcomes, mainly concerning personal health (e.g., item 3 & 14) and social responsibility (e.g., items 13 & 15) and such changes were moderate, as their scores were not far from the mid-point (i.e., 3.00). We labelled the second prole as “overall strong positive changes”. This prole contained about 17.2% of the participants. Participants in this prole reported positive changes in all the listed aspects of life outcomes at high level (i.e., >4.00). We labelled the third prole as “partial positive changes”. This prole contained about half of the participants (49.5%). Participants in this prole showed positive changes in several aspects related to self-care (e.g., items 4, 5, & 14), positive virtues (e.g., items 7 & 12), social responsibility (e.g., items 11, 13 & 15), and emotional and psychological well-being (e.g., items 17 to 19). The magnitudes of changes in these aspects were higher than the mid-point but did not reach high levels (>4.00).


Background
Although the existing literature has well documented the negative effects of COVID-19 on multiple life outcomes in adolescents, some research has also revealed that some life outcomes have become better during COVID-19. Scant research has speci cally examined to what extent and in what aspects COVID-19 is bene cial to adolescent development so far. With person-centered approach, this research addressed this gap by: (1) exploring different pro les of positive changes in life outcomes in Chinese adolescents since the outbreak of  (2) examining the role of resilience in relation to different pro les; (3) comparing mental health across adolescents categorized into different pro les.

Method
Participants were 2,567 Chinese adolescents aged 12 to 24. They rated how much their lives of different domains had experienced positive changes since the outbreak of the pandemic. They also answered the questionnaires that measured their resilience and mental health.

Results
Results of latent pro le analysis revealed three different pro les: limited positive changes (33.3%), partial positive changes (49.5%), and overall strong positive changes (17.2%). Moreover, adolescents with a higher level of resilience were more likely to be categorized into the partial positive changes pro le compared to the limited positive changes pro le and into the overall strong positive changes pro le compared to the other two pro les, after controlling for the covariates. Finally, adolescents in the overall strong positive changes pro le had better mental health than their counterparts in the other two pro les.
Conclusion COVID-19 might be helpful to adolescent development to some extent, especially for those with higher resilience.

Background
The outbreak of coronavirus disease  has affected most people globally (1). Governments are implementing strict measures against the spread of the coronavirus, such as lockdowns, study/work from home, physical distancing, limitation of social interactions, and quarantine. Despite its effectiveness to stop the coronavirus, the measures also have side effects such as increasing people's isolation and stress (2). Adolescents, the population aged 10 to 24 (3)[i], are considered particularly vulnerable to the social effects of the measures against COVID-19 (4). Adolescence is a developmental period marked by rapid physical and social-emotional changes, onset of many mental disorders, and increased time investment with peers (5, 6), but the measures have disrupted adolescents' life structure and may result in multiple negative life outcomes. Research has well documented the negative effect of COVID-19 on adolescents' psychosocial outcomes, such as poorer mental health, decreased well-being, reduced physical activity, more alcohol use, and increased screen time (7)(8)(9)(10).
Nevertheless, some studies also unexpectedly found that COVID-19 induced positive changes in some life outcomes in adolescents, such as increased psychosomatic health and more time to sleep (8, 9). These ndings lead to an intriguing, yet rarely explored, question: can COVID-19 be bene cial to adolescents' life outcomes? A recent review has discussed this question, postulating that successfully navigating the challenges of COVID-19 would strengthen adolescents' sense of community, family cohesion, and personal growth and mental health (4). The study further considered that young people's ability to cope with the pandemic is determined by demographic, social (e.g., social support), and individual (e.g., ability to make meaning from the crisis) factors.
Only a few studies have examined positive changes in life outcomes in adolescents during COVID-19. One research examined this topic during the initial lockdown in Scottish adults (11). It found that the participants reported positive changes in various life outcomes, with higher levels in some aspects (e.g., more appreciative of things usually taken for granted) than in others (e.g., spent less time on screen or devices outside of work hours). The results also found that females, younger people, and individuals with better health reported higher levels of positive changes. This study, however, did not focus on adolescents and it did not examine the individual antecedents or mental health outcomes. Moreover, the effects on adolescents' positive changes in life outcomes may differ across countries, as the measures adopted by different countries differ in intensity, effectiveness, and duration. However, it is unknown whether adolescents from other countries (e.g., China) would experience similar patterns of positive changes. As people's psychological functioning may manifest in different pro les when the pandemic has evolved for a period of time, person-centered approach with multiple indicators is considered an appropriate method to capture this complex patterns (12). Therefore, the aim of this study was threefold. First, we explored different pro les of positive changes in life outcomes in Chinese adolescents over the past two years in a national sample (N=2,567). This topic is exploratory in nature, but we expected that distinct pro les would emerge. Second, we examined the extent to which resilience, de ned as one's ability to bounce back from external stressor (13), would be related to the membership of pro les. Given that resilience is an important asset that helps young people deal with crisis such as COVID-19 (14), we hypothesized that adolescents with high levels of resilience would be more likely to be in a pro le indicating more positive changes. Third, we examined mental health as a function of pro les. Based on prior viewpoints (4), we hypothesized that adolescents in a more positive pro le would have better mental health than those in a less positive pro le.
[i] We pre-registered that this study would focus on adolescents aged 12 to 25. But in this study we decided to focus on adolescents aged 12 to 24 to follow the de nition of adolescents by Sawyer et al. (2018).

Method Participants and Procedure
Participants of this study were from a larger survey that investigated Chinese public's intention/motivation of getting COVID-19 vaccine and its correlates. Student helpers (N=168) from various regions in China volunteered to spread an online survey link on their social networks via different social media platforms (e.g., WeChat). Within the survey period (from 23-July to 12-August, 2021), 3,273 participants provided consent and completed the survey. As a quality control, we excluded a number of participants because: (1) their age was out of our expected range (<12 or >90 years old; N=11); (2) they were living oversea (N=7); (3) they had duplicate IP address (N=195), or (4) they answered the survey too fast according to Leiner's (2019) relative speed index (>2; N=75)[i] (15). The remaining 2,985 participants constituted the nal sample of the larger survey (M age =22.07 years; 1,019 males).
Adolescents aged 12 to 24 from the said larger survey consisted of the sample of this study. The current sample size was 2,567 adolescents from 32 provinces/regions in China (850 males; M age =19.87 years, SD=2.02). Among them, 157 and 28 participants reported that they had history of physical or psychiatric illness, respectively; and 44 participants reported that they were directly related to COVID-19 (e.g., con rmed/suspicious cases and/or relatives/friends of the con rmed cases, etc.). This study was approved by the ethical committee of xx University. The survey was conducted online. Participants (or their guardians) provided consent by checking the box in the front page of the survey that fully explained the study. They reserved the right to withdraw from the survey at any point. Participation was voluntary and no incentive was provided. We did not collect identi able personal particulars and con dentiality was stressed.

Positive Changes in Life Outcomes
We adapted the positive events subscale of the Epidemic-Pandemic Impacts Inventory to measure used in previous study to measure Chinese adolescents' positive changes in life outcomes (11). The previous study used 21 items measuring whether participants had experienced positive changes during the initial lockdown across a number of life outcomes (e.g., relationships, physical activity, sleep, work) with binary response options (11). In this study, we modi ed this subscale in several aspects to suit the current participants better. First, we grouped some items that had similar meaning. For instance, in the original subscale, the items "more quality time with partner or spouse" and "more quality with children" were combined and modi ed as "more quality time with family members". Second, social media information was lled with positive energy (e.g., sharing of gratitude, appreciation, social responsibility)(16) and patriotism (17) in China over the last two years when the government was combating COVID-19. In this regard, we added a few items that re ected this situation, such as "become more gratitude" and "become more patriotic". Finally, we changed the binary response options to a ve-point scale (from 1=strongly disagree to 5=strongly agree). A higher score indicates higher levels of positive changes in life outcomes. The nal scale has 19 items. Participants were asked to rate how much they had experienced the listed positive changes in various life outcomes since the outbreak of COVID-19. The full set of items are illustrated in Table 2. The Cronbach's a of this scale was 0.95 in this study.

Resilience
We used the Brief Resilience Scale (13) to measure participants' ability to bounce back. In this study, the Chinese version of BRS was used (12). This scale has 6 items rated on a ve-point scale (from 1=strongly disagree to 5=strongly agree). A higher mean score indicates better ability to bounce back from stressors. Sample items are "It does not take me long to recover from a stressful event" and "I usually come through di cult time with little trouble". The Cronbach's a of this scale was 0.69 in this study.

Mental Health
We used GHQ-12 (18) to measure participants' mental health. The Chinese version of this scale was used (19). This measure consists of 12 items which are either stated in negative or in positive wordings. Participants were asked to rate on these items according to their situation over the past month compared to their usual situation. All items are rated on a four-point scale (from 1=better than usual to 4=much worse than usual). A higher mean score indicates more mental health problems (i.e., less mental health). Sample items are "feel unhappy and depressed" and "lose con dence in self". The Cronbach's a of this scale was 0.90 in this study.

Covariates
We measured several demographic variables as covariates, as they had been found to be associated with various life outcomes in Chinese public at the beginning period of COVID-19 (20). These covariates include biological sex (1=male, 2=female), age, their relationship with COVID-19 (1=directly related, such as con rmed/suspicious case and/or relatives/friends of the con rmed cases, etc., 2=not related), history of physical and psychiatric illness (1=yes, 2=no), and their current physical health condition (from 1=very poor to 5=very good).

Data Analyses
We analyzed the data with SPSS 26.0 and Mplus 7.31 (21). The variables examined in this study had never been used in other studies. The research question, hypotheses, and the data analytic plan were pre-registered at aspredicted.org (protocol number: #73896). First, we conducted preliminary analyses, including means and standard deviation. Second, we carried out latent pro le analysis (LPA) to examine the rst research question. All the 19 items listed in Table 2 were used as the indicators of analysis. We rst started with one-pro le, and then increased the number of pro les systematically until we identi ed the best tting model according to a number of indices, including Akaike Information Criteria (AIC) (22), Bayesian Information Criterion (BIC)(23), adjusted BIC (aBIC), Lo-Mendell-Rubin Adjusted Likelihood Ratio Test (LMRT) (24), and Bootstrapped Likelihood-Ration Test (BLRT) (25). Smaller values of AIC, BIC, and aBIC indicated better model t. The p-value values associated with LMRT and BLRT indicate whether the k-pro le model (p <.05) or the k-1 pro le model (p >.05) has a better t. Besides, the value of entropy no less than 0.6 indicates good pro le separation (26). In addition, we also considered theoretical meaningfulness of the pro le (27) and the proportion of participants represented in the pro les (28). As a rule of thumb, no pro le should have a group comprised of less than 5% of the participants (29). Multivariate analysis of variance (MANOVA) was conducted to examine whether the mean level of each indicator signi cantly differed across pro les. P-values and effect sizes (η 2 p ) were used to judge the signi cance. Third, we performed a logistic regression model using a three-step procedure in Mplus (i.e., R3STEP auxiliary command)(26) to examine the second research question after identifying the best-tting model. Logits from the model output were transformed into odd ratios for explanation purposes. Demographic variables measured above were included in the model as covariates. Fourth, analysis of variance (ANOVA) was performed to examine the third research question, with the average score of GHQ as the dependent variable and the pro les as the independent variables. Both p-values and effect size (η 2 p ) were used to determine the signi cance. Based on ANOVA, we further conducted ANCOVA controlling for covariates. Finally, as a robust check, we replicated the analyses for research questions 2 and 3 with winsorized scores of resilience and GHQ[ii], respectively.
[i] Leiner's (2019) relative speed index was calculated in the following steps. First, although the questionnaires administered to participants who had and who had not got vaccinated were largely the same, several questionnaires were different, thus resulting in different completion time between the two groups of participants. Hence, we split the two groups and gauged the relative speed index of each participant for each group. Second, we calculated the median completion time for each group. Third, we used each participant's completion time to divide the median completion time of the group he/she was in, and a relative speed index could be obtained. For instance, if the median completion time of the non-vaccinated group was 600 seconds, a participant in this particular group had a completion time of 200 seconds. Then, this participant's relative speed index was 600/200 = 3 and he/she should be excluded because his/her index was larger than the cut-off point (i.e., 2).
[ii] Winsoring approach (Tukey, 1962) was used to handle the outliers of the resilience and GHQ by replacing the outliers with the nearest number within the -3 to +3 SD range.

Preliminary Analysis
Descriptive analysis found that participants overall reported above-medium levels of positive changes in life outcomes (M=3.74, SD=0.61). Besides, participants reported medium level of ability to bounce back (M=3.17, SD=0.55) and low levels of mental health problems (M=1.95, SD=0.49).

Pro les of Positive Changes in Life Outcomes
As shown in Table 1, latent pro le analysis found that the 3-pro le solution described the optimal number of pro les for life changes. According to the t indices, the 3-pro le solution demonstrated a better t than the 2-pro le solution, as indicated by signi cant LMRT (p <.001) and BLRT (p <.001). By contrast, the 4-pro le solution was not better than the 3-pro le solution, as indicated by insigni cant LMRT (p=.533). Besides, the values of AIC, BIC, and aBIC decreased as the number of pro les increased, and such decrease appeared more apparent between 1-pro le and 2-pro le solutions and between 2-pro le and 3-pro le solutions than the one between 3-pro le and 4-pro le solutions. Moreover, no group contained less than 5% of the participants for the 3-pro le solution, but one group of the 4-pro le solution contained less than 5% of the participants. Taken together, we selected the 3-pro le solution as the nal solution. This solution showed high entropy (i.e., 0.93). The average posterior pro le membership probability was high, with 96.7%, 97.1%, and 97.2% for the rst, second, and the third pro le, respectively. Table 2 presents the raw score of each indicator of each pro le and the results of MANOVA. We labelled the rst pro le as "limited positive changes". This pro le consisted of 33.3% of participants. Participants in this pro le showed positive changes in only a few aspects of life outcomes, mainly concerning personal health (e.g., item 3 & 14) and social responsibility (e.g., items 13 & 15) and such changes were moderate, as their scores were not far from the mid-point (i.e., 3.00). We labelled the second pro le as "overall strong positive changes". This pro le contained about 17.2% of the participants. Participants in this pro le reported positive changes in all the listed aspects of life outcomes at high level (i.e., >4.00). We labelled the third pro le as "partial positive changes". This pro le contained about half of the participants (49.5%). Participants in this pro le showed positive changes in several aspects related to self-care (e.g., items 4, 5, & 14), positive virtues (e.g., items 7 & 12), social responsibility (e.g., items 11, 13 & 15), and emotional and psychological wellbeing (e.g., items 17 to 19). The magnitudes of changes in these aspects were higher than the mid-point but did not reach high levels (>4.00).
We conducted a MANOVA to examine whether the indicator scores were different across the three pro les. The results indicated a signi cant multivariate test, Wilk's λ=0.17, F(38, 5092)=188.61, p<.001, η 2 p =.59. Results of between-subject effects revealed signi cant main effect for each indicator. Post-hoc multiple comparison with Bonferroni correction found that the over strong positive changes pro le had a signi cantly higher level on each indicator than the other two pro les and that the partial positive changes pro le in turn had a signi cantly higher level of each indicator than the limited positive changes pro le.

The Association between Resilience and Different Pro les
The results of logistic regression are summarized in Table 3. As shown, compared to the limited positive changes pro le, participants with 1 unit increase in resilience were 2.01 and 1.43 times more likely to be the members of the overall strong positive changes and the partial positive changes pro le, respectively, net the effects of covariates. Moreover, compared to the partial positive changes pro le, participants with 1 unit increase in resilience were 1.40 times more likely to be the members of the overall strong positive changes pro le, even after controlling for covariates. In addition, replication with winsorized resilience score as the predictor yielded very similar ndings.

The Differences in Mental Health among Different Pro les
The results of ANOVA analysis found a signi cant main effect across the limited positive changes (M=2.09, SD=0.45), partial positive changes (M=1.91, SD=0.44) and overall strong positive changes (M=1.79, SD=0.62) pro les, F(2, 2564)=65.77, p <.001, η 2 p =.05. Post-hoc multiple comparison with Bonferroni correction found that the adolescents in the overall strong positive changes pro le had a signi cantly lower level of mental health problems than those in the other two pro les and that adolescents in the partial positive changes pro le had a signi cantly lower level of mental health problems than those in the limited positive changes pro le. We further conducted ANCOVA analysis controlling for covariates, the effect of pro le on mental health problems remained signi cant, F(2, 2558)=32.10, p <.001, η 2 p =.02. In addition, replications with winsorized GHQ-12 score as outcome yielded very similar ndings for both ANOVA and ANCOVA analyses.

Discussion
This research generated three ndings. First, three qualitatively distinct pro les of positive changes in life outcomes emerged in Chinese adolescents. Second, adolescents with a higher level of resilience were more likely to be in a more positive pro le than those with a lower level of resilience. Third, more positive changes in life outcomes were related to better mental health. Altogether, these results advance our understanding of an underexplored research topic: to what extent and in what aspects COVID-19 is bene cial to adolescent development.
Previous studies found that while COVID-19 deteriorated some life outcomes (e.g., screen time, mental health, and well-being) it increased other outcomes (e.g., psychosomatic health and sleep time) (8, 9). The emergence of three different pro les of this study reconcile the said inconsistent ndings. A recent review has pointed out that people's adjustment outcomes may vary across domains and over time during COVID-19, with some people showing better outcomes in some aspects at a certain period and other people in other aspects at a different period (12). Our ndings are consistent with this viewpoint. As illustrated in Table 2, some participants showed positive changes in more aspects and reported higher levels of positive changes than others. This nding is also consistent with prior research that found that Scottish public generally reported positive changes in multiple life domains but that the intensity of changes varied across domains (11).
Of note, participants across pro les showed relatively higher positive changes in life outcomes related to personal health and survival (e.g., pay more attention to physical health) and to social and ideological issues (e.g., become more patriotic). According to terror management theory (30), the former may re ect that adolescents manage the anxiety induced by the pandemic through actively engaging in thoughts and behaviors that prolong their survival. The latter may result from the (positive) information spread among the Chinese public during COVID-19 (16). Moreover, participants across pro les showed relatively lower levels of positive changes in issues related to routines (e.g., spent less time on screen and sleep quality). This may be because school closure has been enforced and online learning via digital devices has been adopted from time to time in different regions over the past two years. Regarding screen time, research found increased in frequency and duration of recreational internet use in Chinese children and adolescents, especially among boys (31), probably because of more access to digital device during the pandemic. In sum, these ndings implied that the preventive measures appeared to affect Chinese adolescents' routine quite extensively.
As predicted, adolescents with a higher level of resilience were more likely to be in the pro le indicating more positive changes. According to the risk-resilience model, individuals with more personal or social assets would better cope with stressors to maintain adjustment (32).
In support of this idea and prior ndings (13,14), the current ndings suggest that resilience is an essential personal asset that helps adolescents navigate the stressors during COVID-19 and achieve more positive changes. One possible explanation may be because resilience supports adolescents' re ective functioning, which is an essential factor that facilitates effective meaning-making from stressful events and personal growth (33-35). A clinical implication of this nding is that enhancing adolescents' ability to bounce back might be a promising way to help them achieve personal growth during the pandemic.
Adolescents perceiving overall strong positive changes in multiple life outcomes over the past two years showed better mental health over the past month, which con rmed our hypotheses. This nding is not surprising, as participants who are resilient, successfully recover from, and effectively make meaning of the pandemic are more likely to have better adjustment, such as mental health (12). This research has several limitations. First, the life outcomes examined in this research are not exhausted, although these outcomes are appropriate to Chinese adolescents and most of them have been examined in prior research (11). Second, this sample was not nationally representative, as girls were over represented according to Chinese census (36) and the sample size of different regions differed considerably. Third, utilizing longitudinal design to examine adjustment during COVID-19 is promising as it allows direct comparison across periods (12), but the design of this research is cross-sectional in nature. Nevertheless, we reckon that the current ndings are still valuable in that they re ect adolescents' overall perception of the positive changes in life outcomes over the past two years. These results are meaningful, as scant research has speci cally examined the positive psychosocial effect of COVID-19 on adolescent development so far. Future research may continue examining this topic with more sophisticated measurement, more representative samples, and longitudinal design. In addition, cross-cultural comparison would be also promising, as how adolescents perceive their lives are affected by COVID-19 could be determined by the situations of the pandemic and the effectiveness as well as the impacts of the measures used to stop the virus in different nations.
Does COVID-19 only induce negativity? Our ndings reveal that Chinese adolescents have generally perceived positive changes in different domains of life outcomes over the past two years, although some of them perceive positive change in more life domains and at higher levels than others. Resilience is a vital factor associated with adolescents' perceived positive changes. Finally, positive changes in more domains and at higher levels are related to better mental health. Altogether, these ndings imply that COVID-19, as an external stressor, might be helpful to adolescent development to some extent, especially for those who are more psychologically resilient. Given the scarce of this topic, we encourage continuous research on this topic.