In the study, LCA was used to classify the college students’ depressive symptoms during the epidemic. Our findings revealed distinct patterns and characteristics within the depressive symptoms exhibited by Chinese college students during the epidemic. Based on statistically supported indicators and clinical implications, we identified four latent classifications: the 'low-symptom group' (35.57%), the 'moderate-symptom group' (20.97%), the 'major-symptom with low-risk of suicide group' (17.88%), and the 'major-symptom with high-risk of suicide group' (25.58%). Additionally, the paper reported that several risk factors including high IU, residing in uninfected area, female, non-exercise, being unvaccinated and experiencing a severe impact on family economy were significantly associated with increased risk of depressive symptoms.
As mentioned above, LCA is a fundamental research method, which could group the individuals into classes with similar patterns of some behaviors based on their response to certain observed indicators(Magidson, Eagle, & Vermunt, 2003). Four interpretable subtypes of depressive symptoms based on LCA models were described in the current analysis, and the entropy of the four-class model (0.80) indicated good membership classification. Besides, prior studies have noted the importance of LCA in the classification of mental health due to its practicability of addressing pertinent questions (Au, Andino, Mekawi, Silverstein, & Lamis, 2020; Liao et al., 2019). LCA was generally implemented to explore the health risk behaviors of college students in various papers(Assanangkornchai, Li, McNeil, & Saingam, 2018; Nelon et al., 2019). These consistent findings further underscore the validity and applicability of LCA as a valuable method in mental health research.
Moreover, the study found that there were the significant differences in IU among different subgroups. Specifically, the number of students with higher IU scores was significantly higher in the 'major-symptom with high-risk of suicide group' compared to the 'low-symptom group'. The risk of college students with high IU entering the ‘major-symptom with high-risk of suicide group’ was even 15.81 times higher than that of students with low IU, relative to those in ‘low-symptom group’. The odds ratio (OR) increased from 3.77 to 12.31 and then to 15.81, indicating that the OR increased with the severity of depressive symptoms. These finding showed that the college students with high IU may experience severer suicidal ideation and depressive symptoms. A recent paper suggests that IU contributes to both chronic suicide risk and acute suicidal acts(Allan, Gorka, Saulnier, & Bryan, 2023). While, few recent studies explored the relationship between IU and depressive symptoms, particularly with regard to suicidal ideation. Therefore, the finding highlighted the importance of IU in mental health and extended the existing researches in this area.
Interestingly, contrary to previous studies that have reported higher prevalence of depression and anxiety in the infected group due to quarantine measures(L. Lei et al., 2020; T. Wang, Yang, & Na, 2021), our study yielded surprising results. We found that infected areas with more strictly restriction measures had a lower risk of depression. The results in the paper were severely inconsistent with previous studies. We observed that the ‘low-symptom group’ showed a significantly higher number of college students in the infected area compared to uninfected area, while the ‘major-symptom with high-risk of suicide group’ showed a significant higher number of college students in the uninfected area. Furthermore, the variable of ‘uninfected area’ was found to be significant in the MLR analysis and identified as a risk factor. Specifically, the article suggested that the risk of students in uninfected area entering the ‘major-symptom with high-risk of suicide group’ was 2.31 times higher than that in infected area, relative to the ‘low-symptom group’. These findings indicate that students who were geographically distant from the center of the epidemic exhibited more severe depressive symptoms. The unexpected results may be explained by the psychological typhoon eye effect, which may due to the individuals in the infected area could correct the information about COVID-19 epidemic according to their objective experience in the initial stage of epidemic outbreak but those in uninfected area may be misled by the media information (T. Liu, Li, Qiao, & Song, 2021). Therefore, the government or related departments should prioritize the depressive symptoms of college students, particularly those in the uninfected, in order to alleviate stress and promote efficiency of related departments and governments.
Additionally, the paper investigated the relationship between the subgroups and various risk factors, including vaccination, time of daily exercise, gender, family member, family economic impact, time for browsing COVID-19 information. Relative to ‘low-symptom group’, individuals in ‘major-symptom with high-risk of suicide group’ were more likely to be unvaccinated. One possible explanation for this might be that those who were unvaccinated may resist to be vaccinated and were discriminated against by who were vaccinated, which was shown in Luca’ study (Henkel, Sprengholz, Korn, Betsch, & Bohm, 2023). Our results also revealed that the family economic impact could significantly predict subgroups of depression, which was consistent with previous study(Van Lancker & Parolin, 2020). This may be explained that the previous economic recession intensified college students’ poverty, which had a lasting impact on the health, well-being, and academic performance of college students(Schippers et al., 2022). Another interesting finding was that individuals in ‘low-symptom group’ were more likely to keep exercising every day. It is well known that physical activity and exercise can alleviate some symptoms associated with mild to moderate depression(Taylor, Sallis, & Needle, 1985). The results supported the previous studies and the recent studies also provided the evidence that exercise can reduce the symptoms of anxiety, stress, and depression during COVID-19 (Chen & Lucock, 2022; Magson et al., 2021; Pears, Kola-Palmer, & Azevedo, 2022). In the MLR analysis, the risk of female students entering the ‘major-symptom with low-risk of suicide group’ was 1.37 times higher than that of male students, indicating that female students have more prominent mental health status, which may be attributed to the different stressor event and hormone(Yanping et al., 2021). The gender differences in mental health among college students align with previous studies(Y. Liu, Frazier, Porta, & Lust, 2022). However, in the comparison between the ‘moderate-symptom group’ and the two major-symptom groups, the OR of female was less than 1, suggesting that males were at a higher risk of severe depressive symptoms once they experienced them. This result reminded the related department of paying more attention to those male students to solve their mental problems as the symptom they got may be severer. Overall, these findings provide valuable insights into the menta health of college students during the epidemic and emphasize the need for targeted interventions to address mental health issues in this population.