Mental health status among non-medical college students during the COVID-19 pandemic in Zhanjiang city

doi:10.21203/rs.3.rs-1839216/v1

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Mental health status among non-medical college students during the COVID-19 pandemic in Zhanjiang city

https://doi.org/10.21203/rs.3.rs-1839216/v1

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Objectives: The coronavirus disease-2019 (COVID-19) pandemic has brought great changes to people's lifestyles. Previous reports implied that college students are more vulnerable to mental disorders. We aimed to evaluate the mental status of non-medical college students during the outbreak of COVID-19 in Zhanjiang city.

Methods: 1083 non-medical college students aged 18-25 years old were enrolled in this study. An online survey was applied to collect demographic data. Sleep quality, anxiety and depression symptoms were analyzed by pittsburgh sleep quality index (PSQI), hamilton depression rating scale-17 (HDRS-17) and self rating anxiety scale (SAS), respectively.

Results: There are 93.2% students had good sleep quality, 6.8% students had poor sleep quality. There are 97.4% students had no anxiety, 1.86%, 0.37% and 0.37% students had mild, moderate and severe anxiety, respectively. 66.9% students had no depression, 26.7%, 4.7% and 1.7% students had minimal, mild-moderate and severe depression. The sleep quality of students in different grades showed no statistical significance. Female students had higher proportions of anxiety (p=0.02) and depression (p>0.0001) than male students. No statistical difference was found in different educational levels regarding to anxiety and depression. The students whose household income that lower than 3000 RMB were more vulnerable to anxiety (p=0.017) and depression (p=0.004).

Conclusions: During the COVID-19 pandemic, a majority of students remain good sleep quality and positive mental health and a small number of students showed depression. Female students and lower household income were positively related to the prevalence of anxiety and depression. To our knowledge, this is the novel study revealing the mental health of non-medical college students concerning COVID-19 in Zhanjiang.

COVID-19 pandemic

Sleep quality

Anxiety

Depression

Mental health

2019 coronavirus disease (COVID-19) was first reported in Wuhan, China in December 2019. COVID-19 was an infectious disease which mainly transmitted through respiratory droplets and direct contact. As of June 04, 2022, a total of 45,048,617 person diagnosed with COVID-19 and 6319091 died of this deadly infectious disease. In Zhanjiang, Guangdong, a total of 109 positive cases were reported, including 85 confirmed cases and 24 asymptomatic cases. Recent studies have reported that there is increasing levels of stress or mental illness due to the COVID-19 pandemic.¹ The mental health of vulnerable populations, especially college students have aroused public’s concern. Anxiety, depression and insomnia has become the most common issues among college students. Therefore, to evaluate the mental health of college students is of great importance.

Several retrospective studies suggested that infection was closely related with subsequent mood deterioration, including depression.² It is reported that approximately 340 million people suffer from depression and this mental illness is a major cause of disability, and contributes a lot to health burden.^3,4 A systematic review and meta-analysis implied that the prevalence of anxiety, depression, and insomnia symptoms among healthcare workers during COVID-19 pandemic were 23.2%, 22.8%, and 38.9% respectively.⁵ A study has shown that infectious disease like HIV could increase depression level of patients tested by Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire.⁶ Income stability and high educational level were negatively related with anxiety and depression levels and poor sleep quality.⁷ However, the participants enrolled in the above studies mainly fucus on medical workers or patients, the mental health under the COVID-19 pandemic await to be assessed among non-medical students.

The aim of this study was to evaluate the mental health status among non-medical college students during the COVID-19 pandemic in Zhanjiang city and distinguish the students who might need psychological intervention.

Sample size calculation

The sample size was calculated using Power Analysis and Sample Size (PASS) 11.0, with reference to previous studies, the prevalence of anxiety in college students was 23.8%.⁸ The PASS operating parameters were as follows: “Proportions” --- "one proportion” --- "Confidence Intervals for one proportion”, 1-α = 0.95, Confidence interval width = 0.1, p = 0.238. Results showed that at least 297 people were required to meet statistical differences. Considering the 10% drop-out rate, we should at least enroll 327 students.

Study population and enrollment criteria

This cross-sectional study was launched by means of online survey (WeChat App) between April 1, 2022-june 1, 2022. The mental health status (insomnia, depression and anxiety) of non-medical students in Zhanjiang city was evaluated during the pandemic of COVID-19. The inclusion criteria are as follows: Age ≥18 years old and voluntarily participate in this study. Exclusion criteria are as follows: Students with no capacity or visual impairment or history of mental illness. The validity of the questionnaires for each participant was limited to one week as longer period might affect the psychological condition of the participants.

Insomnia, depression and anxiety evaluation

Insomnia was assessed by pittsburgh sleep quality index (PSQI). Depression and anxiety were evaluated by hamilton depression rating scale-17 (HDRS-17) and self rating anxiety scale (SAS), respectively. These scales were frequently applied and considered as valuable screening instruments among various population for insomnia, depression and anxiety.^9-11 In furtherance, the demographics information including age, gender, educational level, grade and household income were collected.

The sleep quality was identified by PSQI. There are 19 questions in this scale and higher score implied worse sleep quality. PSQI score were calculated and score > 5 and ≤ 5 were considered as poor and good sleep quality, respectively.⁹ The contents of HDRS-17 include depressed mood, feelings of guilt, suicide, agitation et, al. HDRS-17 score ＜8 indicates no depression,¹⁰ score 8-16 indicates minimal depression, score 17-24 indicates mild-moderate depression,¹² score ≥25 indicates severe depression.¹³ SAS was appplied to assess anxiety, with the definition of normal (≤ 49), mild (50-59), moderate (60-70) and severe anxiety (≥ 70) .¹¹

The informed consent of each study population was obtained and the answers to the specific demographic questions and insomnia, depression and anxiety scales were collected electronically. Study objectives was extensively explained at the beginning of the survey.

Statistical analysis

Statistical analysis was performed by using GraphPad Prism 7.0 and SPSS 22.0 (SPSS Inc., Chicago IL, USA). Kolmogorov–Smirnov test was used to examine the data normality. The chi-square test or Fisher's exact test was used to compare the sleep quality, anxiety and depression among different educational levels, grades, gender and household income. Differences with p < 0.05 were considered statistically significant.

Characteristics of the participants

A total of 1083 no-medical students were enrolled in this study. As shown in Table 1, the majority of participants were females (n = 981, 90.6%). There are 475 participants (43.9%) aged between 18 and 19 years old and 608 participants (56.1%) aged between 18 and 19 years old. The educational level of most participants is junior college or above (n = 1045, 96.5%), and the educational level of 38 (3.5%) are technical secondary school. Around half of the participants are freshman (n = 525, 48.5%), and there are 462 (42.6%) and 96 (8.9%) participants are sophomore and junior or above, respectively. There are 294 participants (27.1%) owned a monthly household income of less than 3,000 RMB and 789 participants (72.9%) held more than 3000 RMB.

Table 1

Demographics of the participants
Demographics	n (%)
Age
18–19 years old	475 (43.9%)
20–25 years old	608 (56.1%)
Gender
Male	402 (37.1%)
Female	681 (62.9%)
Educational level
Technical Secondary School	38 (3.5%)
Junior College or above	1045 (96.5%)
Grade
Freshman	525 (48.5%)
Sophomore	462 (42.6%)
Junior or above	96 (8.9%)
Household income
<3000/month	294 (27.1%)
≥3000/month	789 (72.9%)

Prevalence Of Sleep Quality, Anxiety And Depression Among The Participants

As presented in Table 2, most participants had good sleep quality (n = 1010, 93.2%), and 73 people (6.8%) had poor sleep quality. The prevalence of anxiety among the participants was as follows: no anxiety (n = 1055, 97.4%), mild anxiety (n = 20, 1.86%), moderate anxiety (n = 4, 0.37%) and severe anxiety (n = 4, 0.37%). The proportions of no, minimal, mild-moderate and severe depression were 66.9%, 26.7%, 4.7% and 1.7%, respectively.

Table 2

Prevalence of sleep quality, anxiety and depression among the participants
	Overall (n = 1083)
Sleep quality
good	1010 (93.2%)
poor	73 (6.8%)
Anxiety degree
no anxiety	1055 (97.4%)
mild anxiety	20 (1.86%)
moderate anxiety	4 (0.37%)
severe anxiety	4 (0.37%)
Depression degree
no depression	725 (66.9%)
minimal depression	289 (26.7%)
mild-moderate depression	51 (4.7%)
severe depression	18 (1.7%)

As shown in Fig. 1, there was no significant differences among different grades (freshman, sophomore, junior or above) regarding to sleep quality (Chi-square test, p = 0.054). There was 3 and 48 of 402 male students had anxiety (0.75%) and depression (2.8%), respectively, and there was 19 and 310 of 681 female students showed anxiety (11.9%) and depression (45.5%). Female students obviously represented more anxiety and depression emotion than male students (anxiety: Fisher’s exact test, p = 0.02, Fig. 2A; depression: Chi-square test, p < 0.0001, Fig. 2B). There was no statistically significant difference in sleep quality between genders (data not shown). The prevalence of anxiety of technical secondary school degree students showed no statistical difference compared with junior college or above degree students (Fisher’s exact test, p = 0.14, Fig. 3A). There were no statistical differences between educational levels in depression (Fisher’s exact test, p > 0.99, Fig. 3B). Furthermore, the participants whose household income that lower than 3000 RMB showed significantly higher anxiety and depression than the participants over 3000 RMB per month (anxiety: Fisher’s exact test, p = 0.017, Fig. 4A; depression: Fisher’s exact test, p = 0.004, Fig. 4B).

In this study, we demonstrated that the majority of the non-medical college students presented with good sleep quality, no anxiety or depression during the prevalence of coronavirus COVID-19 in Zhanjiang city. There is no statistical difference in the sleep quality of students of different grades. No marked difference was found in anxiety or depression in terms of educational levels. Female students and the participants whose household income that lower than 3000 RMB per month were more vulnerable to anxiety and depression.

Previous study reported that 21.6% college students showed various depressive symptoms.¹⁴ Our findings showed a higher proportion of respondents with different levels of depression among non-medical college students. During the prevalence of COVID-19, the students accepted live online learning instead of face-to-face classes, and their activities in public places were restricted.^15,16 We suggested that these altered lifestyle and social patterns might contributed to the development of depression. Depression could lead to reduced quality of life and higher healthcare burden.¹⁷ Therefore, providing early recognition and support for the vulnerable students to manage their mental health is a vital need. One research pointed out that students in higher grades had a lower prevalence of sleep disturbance compared with those in the lower grades.¹⁸ The sleep quality among different grades in this study did not show statistical difference, this implied that the freshmen enrolled were quite adaptable to the new circumstances during the COVID-19 pandemic. The local government and colleges/universities might play important roles in prevention and health education of COVID-19. Low educational level was reported to be related with both anxiety and depression.¹⁹ The prevalence of anxiety and depression showed no statistical significance in our data probably owing to the imbalance in the educational levels of the included subjects.

We found that female students were more prone to anxiety and depression. This result was in accordance with the previous study demonstrating that women were approximately twice as likely to experience mood disturbance as men, including sleep problems, anxiety and depression.^20,21 This sexual discrepancy might due to different sex steroids levels. For example, testosterone has been regarded as an important sex steroid to resist anxiety and depression.²² The influence of economic status of the participants on anxiety and depression should be noted. It is demonstrated that the diabetic patients of Higher-income showed a significant decline for anxiety.²³ People with low socioeconomic status have a high incidence of anxiety and depression.²⁴ Similarly, our result also revealed that subjects with higher household incomes had lower rates of anxiety and depression. Given the use of a online survey, there might exist some response bias. Furthermore, mood disturbance was reported to be associated with inflammatory processes.²⁵ We suggest that it would be interesting to study the immunological changes in the participants in the next study. To our knowledge, this is the novel cross-sectional study aiming at evaluating the mental health problems among non-medical college students in Zhanjiang. The results from this study might help in guiding healthcare practitioners and policymakers to work out appropriate and feasible interventions to recognize and treat the students with mental disorders.

Conflict of interest

The authors declared no potential conflicts of interest of this article

Acknowledgments

We would like to thank the participants who voluntarily participated and professor Jia-yuan Wu for his support in statistics.

Author contributions

Xiaojun Deng and Huiting Zhang designed the study. Xiaojun Deng developed the questionnaire, recruited the participants and wrote the main manuscript text. Huiting Zhang revised the manuscript and analyzed the data. The corresponding author (Huiting Zhang) had full access to all the data in the study and had final responsibility for the decision to submit for publication. All authors reviewed and approved the final manuscript.

Funding

This work was supported by Guangdong Medical Research Foundation, Grant/Award Number: B2018048; Science and technology research project of Zhanjiang City, Grant/Award Number: 2018B01012; Research Foundation of Guangdong Medical University, Grant/Award Number: GDMUM201807.

Competing interests

The author(s) declare no competing interests.

Ethics approval

This study was in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics committee of the Affiliated Hospital of Guangdong Medical University approved and supervised this study.

Consent for publication

Not applicable.

Data availability statement

The dataset used and analyzed during the current study are available from the corresponding author on reasonable request.

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No competing interests reported.

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Mental health status among non-medical college students during the COVID-19 pandemic in Zhanjiang city

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Abstract

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Introduction

Methods

Results

Characteristics of the participants

Prevalence Of Sleep Quality, Anxiety And Depression Among The Participants

Discussion

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References

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