In this study, we examined the early effects of the COVID-19 pandemic on the mental and psychological health of 7769 school students in China using the CRIES-13. Based on total CRIES-13 scores, 1639students (21.1%) experienced symptoms of severe psychological stress, indicating an urgent need to understand the impact of such events on the mental health of children and adolescents.
Women are more likely to experience acute stress reactions and to be at higher risk of PTSD than men [24–30].In addition, women often show higher scores than men on the invasion and avoidance factors of the CRIES-13[31, 32]. These sex differences are associated with age, suggesting that older individuals respond differently to stressful events than younger ones [31–37]. Consistent with these results, we found that the largest proportion of students experiencing severe psychological stress were in senior high school. Similarly, studies of children exposed to war violence found older children to be more vulnerable to stress [38]. However, a survey of 8236 US children in grades 4–12 at 6 months after the 9/11 attacks found that primary school students (grades 4–5) were at higher risk of post-traumatic stress symptoms than junior and senior high school students [39]. This discrepancy may reflect that different grades of students may have different degrees of stress disorder under the influence of different events. Future research should focus on more different events.
We found that senior high school students had higher scores on arousal and invasion factors on the CRIES-13, but primary school students had higher avoidance factor scores. This suggests that senior high school students are more likely to feel frightened or anxious, experience flashback reactions associated with the event, and manifest symptoms of arousal. The immaturity of the cognitive process in younger children can make them less susceptible to recurring intrusive thoughts and other cognitive impacts of trauma [40, 41]. A maladaptive cognitive style in adolescents and older children may compromise their ability to regulate emotions, rendering them more vulnerable to PTSD [42].
Based on the regression analysis, we found that the occurrence of cold-related symptoms within one month of participating in the survey significantly influenced stress response. Based on studies of the spread of various viruses, psychosocial factors are related to experimental exposure and infection rates. C-reactive protein (CRP) is an acute-phase reactant downstream of the pro-inflammatory cytokines released during influenza infection [43].Studies have shown that a marker of peripheral inflammation, plasma CRP, may be prospectively associated with PTSD symptom emergence, suggesting that inflammation may predispose to PTSD [44].On the other hand, the increasing number of patients and suspected cases, and the increasing number of outbreak affected provinces and countries have elicited public worry about becoming infected [45]. As we know, the most common symptoms associated with COVID-19 are fever, cough, dyspnea, expectoration, headache, and myalgia or fatigue [46]. This is similar to the symptoms of the common cold [47].Particularly, the relevance of perceived threat for health and life and the experienced feelings of vulnerability as mediating factors [48].It was repored that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19 [49].This is consistent with our research results.
Although previous studies have explored the impact of the SARS epidemic on mental health, this is the first study addressing the psychological impact of COVID-19 on children and adolescents. Using a relatively large sample ranging widely in age, we were able to conduct a cross-sectional study of the mental and emotional status of students at one month after the outbreak began in China. There were no participants from Hubei province, which were subsequently identified as being caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [19].However, this may have caused a bias since the participants were selected from schools in certain regions in China, resulting in findings that may not be generalizable across all children and adolescents. In addition, the survey involved substantially more high school students than primary school students. Even though the timing of the survey may help identify participants who require psychological and clinical intervention, the cross-sectional design meant that we could not assess how persistent the post-traumatic stress symptoms are.