Setting and sample
A cross-sectional survey using structured questionnaires was conducted among university students at Jinan University in Guangzhou, Guangdong, China. The data was collected from 20 Feb. to 20 Mar. 2020. During this period, most areas in China were still under the influence of the COVID-19 pandemic. Given the situation, online questionnaires were distributed to university students via WeChat, Whatsapp, and email. Five hundred and sixty-two participants have taken part in the study. The study was approved by the ethics committee of Jinan University, and participants have provided e-written consents before they answer the questions. After completion of the questionnaire, participants would have a chance to win an RMB 20 coupon in a lucky draw.
Instruments
The questionnaires consisted of COVID-19 knowledge, mindful coping, sense of control, and mental health. Participants’ demographic information was collected, including age, gender, grade, education level, academic major, residence location during the pandemic, and whether confirmed or suspected patients were around.
COVID-19 knowledge: The knowledge questionnaire items were developed based on the Diagnosis and Treatment of COVID-19, National Health Commission, the People’s Republic of China (http://www.gov.cn/zhengce/zhengceku/2020-02/19/content_5480948.htm). In total, there were 23 true/false questions, including two questions regarding the characteristics of coronavirus (e.g., coronavirus is sensitive to heat and UV irradiation), four questions regarding transmission route (e.g., the “silent carriers” who showed no symptoms may also pass the virus to others), four regarding clinical presence (e.g., the light symptoms of COVID-19 include fever and fatigue, and may not show the symptoms of pneumonia), six regarding diagnosis and treatment (e.g., no effective pharmacological treatment for COVID-19 has been developed), and seven questions regarding preventative methods (e.g., using 75% alcohol could be an effective agent against the virus). For each question, participants were asked to respond on a true/false/I don’t know basis. A total score, ranging from 0–23, was obtained by counting the total number of correct answers, with a higher score indicating a higher level of COVID-19 knowledge. The Cronbach alpha in our sample was 0.76, indicating good reliability.
Sense of control: The Chinese version of a 12-item sense of control scale was adopted [13]. It includes two subscales: the personal mastery subscale assesses how people feel they can control themselves (e.g., whether I can get what I want with my own hands), and the perceived constraint subscale evaluates how people feel they cannot control the outcome (e.g., I often feel helpless in dealing with the problems of life). Participants were asked to rate on a 7-point Likert scale (1 = strongly agree, 7 = strongly disagree). After reversely coding the items in the personal mastery subscale, the average score of all items was obtained, with a higher score suggesting a greater sense of control. A previous study in a Chinese sample suggested good reliability and validity of the scale [14], and in our sample, a Cronbach alpha was 0.77, 0.82, and 0.85 for the personal mastery subscale, the perceived constraint subscale, and the whole scale, respectively.
Mindful coping
The mindful coping scale developed by Tharaldsen et al. was adopted in our study [6]. The questionnaire was translated from English to Chinese by an author (FZ), and then it was back-translated by two authors (QT and PX) independently. The scale consisted of 23 items, evaluating an individual’s level of awareness, distraction, negative emotions prevention, and constructive self-assertion. With a 5-point Likert scale (1 = never/hardly ever, 5 = always), participants were asked to choose how they will react when facing difficulties. Total scores of the whole set and four subscales were generated, with a higher score indicating a higher level of mindful coping. In our sample, the Cronbach alpha was 0.74, 0.82, 0.77, 0.89, and 0.89 for the awareness subscale, distraction subscale, negative emotions prevention subscale, constructive self-assertion subscale, and the whole scale, respectively. It suggested good reliability of the Chinese version.
Mental health
The individuals’ mental health was assessed by the Chinese version of the 21-item Depression Anxiety Stress Scale (DASS-21) [15]. The DASS-21 is a well-developed instrument evaluating an individual’s level of depression, anxiety, and stress, with seven items in each subscale. Using a four-point Likert scale, it asked participants whether the described situation applies to them by choosing from 0 “did not apply to me at all” to 3 “applied to me very much.” The total score of each subscale was multiplied by two and ranged from 0 to 42. A higher score means a more severe level of depression, anxiety, and stress. The total score 0–13, 0–9, 0–18 of the subscale means a normal to mild level of depression, anxiety, and stress, respectively. A total score equal to and higher than 14, 10, 19 means the moderate to severe level of depression, anxiety, and stress, respectively [16]. In our sample, the Cronbach alpha was 0.81, 0.80, and 0.87 for the depression subscale, anxiety subscale, and stress subscale, respectively. It suggested an excellent reliability.
Data analysis
Descriptive statistics were analyzed for the demographic variables and scores of measurements questionnaires and scales. Continuous variables were described with mean and standard deviation, and the categorical variables were described with cases (n) and percentage (%). Independent two-sample t-tests to compare continuous variables and chi-square tests for categorical variables were conducted between medical and non-medical students, respectively. Pearson correlation was used to calculate the associations between these variables. Linear regression was performed to estimate the associations between knowledge, sense of control, mindful coping, and mental health status. Univariate analyses were used in Model 2. Model 2 was adjusted for all the demographic variables. All the statistical analysis was performed with STATA software 14.2 (STATA Corp., TX, US). P-value < 0.05 with two tails was considered to be statistically significant.