The findings of this study highlighted the major psychological challenges faced by Chinese college girls during the containment Stage of the COVID-19 pandemic. Compared to the similar domestic and overseas studies, the prevalence of PTSD symptoms in this study was relatively high, nearly one-third of participants met the cut-off for PTSD [9, 10, 28, 29]. This might be partly due to the timing of the study, which was carried out at the early stages of the COVID-19 outbreak. At that time, the overall understanding to the disease, and the corresponding measures of prevention and control to the epidemic was still unclear. In addition, females are more prone to acute stress during major public health emergencies, such as SARS and earthquakes [30, 31]. Furthermore, the international influence of the COVID-19 pandemic and its impact on people’s lives are unprecedented, hence the short-term response of females is so overwhelming that they were likely to develop ASD, and eventually PTSD symptoms if it persists for a period of time. Suffering from PTSD will undoubtedly affect female college students’ physical and mental health, academic performance and work plan, and even their future lives. Therefore, identifying risk factors at the beginning of the epidemic, offering targeted psychological counseling, providing appropriate psychological support and theory-based interventions during the rehabilitation process is particularly important.
People with fair or bad health were not only susceptible to the COVID-19 infection (especially with the lack of proper protection) but also had a poor prognosis once diagnosed. The study results were in line with the previous study that PTSD symptoms were remarkably high among those who perceived themselves not very healthy [32]. During the closed-off period, unhealthy participants might have the need to seek medical treatment or other health services, however, it may become a little difficult due to the traffic control and shortage of medical care in this extraordinary situation [33, 34] With the absence of medical care and medical supply during the epidemic, these unhealthy population were at an increased risk of PTSD symptoms [35, 36]. Therefore, in the COVID-19 era, health officials should carefully weigh risks and benefits when planning medical needs of vulnerable population and chronic patients during the containment period. Basic medical services for these people should be ensured and thus releive their mental stress to avoid the extra burden of other diseases apart from the epidemic.
Consistent with the González-Sanguino C's study, our results revealed that those who had confirmed cases among relatives and friends were prone to have PTSD symptoms, which was found to be one of the strongest predictors of adverse psychological impacts during pandemic of infectious diseases [17]. When something stressful and terrifying happens around someone, they may fell frightened and helpless since they are themselves positively affected by the event [37, 38]. Therefore, they are likely to go into the ‘crisis phase’ which is characterized by crying, stressful, insomnia and nightmares, and eventually develop symptoms of PTSD if conditions persist [30, 39, 40]. This reminds us that we should identify and focus on female college students who have COVID-19 patients among close relatives and friends, guide them to adjust their mentality, divert attention, and provide social support to encourage them to re-plan their lives under existing conditions [41].
Additionally, our self-developed COVID-19-related perceived threat scale uniquely predicted PTSD symptoms among young females, underscoring how the specific features of this pandemic give rise to acute and post-traumatic stress. Participants were not only worried about accidentally getting infected by 2019-nCoV, but also worried that their work and life arrangements would be affected by the growing epidemic. Long-term accumulation of adverse emotions would finally lead to PTSD symptoms including intrusion, avoidance and hyper-arousal, if symptoms persist [32, 40]. There is an urgent need to understand the mechanisms behind their potential PTSD symptoms and formulate specific interventions accordingly. First, the official media, schools and teachers should strengthen the publicity of preventive measures to reduce their perceived infection risks; second, the network structure of online teaching and job recruitment should be improved to alleviate the target population’s concerns about future plans, and to ensure their normal paces of study and work; finally, the government should show confidence to the public in coping with the economic downturn due to the pandemic and provide appropriate subsidies to minimize the impact of the epidemic on individuals, such as measures the UK and Australia adopted [42, 43].
In current study, most of the respondents had high levels of social support, and the support from family, but not from partner or peers was negatively associated with PTSD symptoms, the same trend had been found among U.S. young adults during the COVID-19 pandemic [28]. College students were in home quarantine during the study period, substantial support and security might be important in maintaining the mental health of young adults because many were faced with acute stress and broken rhythm of life, such as holiday extension, financial pressure, undergraduate and unemployment. Emotional support coupled with material security provided by family would be an important factor in protecting them against the risk of PTSD. In contrast, peers may have difficult to provide material and living security considering that they are also young adults experiencing similar struggles. Therefore, family support should be addressed in the whole society to guanrantee psychological wellbeing of college female students during the pandemic.
Another protective factor for PTSD symptoms found from this study was high level of knowledge on COVID-19. With easy access to the internet, the majority of respondents can get instant updates on news related to the COVID-19 outbreak, and these real-time effective information can help keeping students informed on the epidemic, the role of information seemed to be fundamental to cope with the epidemic mentally and physically. A negative relationship between sufficient knowledge and adverse psychological impact of the pandemic was also found in researches conducted by Wang C and González-Sanguino C [15, 16, 44]. However, it should be cautious on the infodemic [45, 46]. Social platforms play an important role in information acquisition and dissemination during the epidemic. Though the information from various sources and platforms are updated in real time, it lacks quality control sometimes. When we are surrounded by information noise, which may have impact on our emotions and behavior, such as the looting of Shuanghuanglian in the early stage of the epidemic in China, worries, fear and panic driven by false information may cause people to develop PTSD symptoms. Therefore, it is necessary to ensure that up-to-date, accurate and scientific information can be obtained from reliable sources to avoid panic caused by insufficient and inaccurate information and knowledge.
This study has several limitations to acknowledge. First, the generalizability of our conclusions is impacted given the results were possibly due in part to nonrandom selection of the sample, the possibility of sampling bias should be considered. Second, the uncontrolled online observational study of college students and the cross-sectional nature of the data warrant further longitudinal studies to determine the predictors of PTSD symptoms during the outbreak. Furthermore, the different psychological scales used in this studies may lead to different measurement outcomes compare to other similar studies. Finally, this study relied on anonymous network responses and self-reported answers regarding experience during home-quarantine stay which may not align with clinical psychological diagnosis.
In summary, the findings from this study provide a basis for implementing measures to improve the mental health among college female students during the outbreak of COVID-19 and have a reference value for identifying students who may have a high risk of adverse psychological problems. Our study has a number of strengths, including a large sample size and robust statistical analysis. Additionally, in order to verify the relationship between knowledge of COVID-19 and PTSD, we have designed a 14-item COVID-19-related knowledge and behavior questionnaire, including basic information about COVID-19, main symptoms, routes of transmission, and health behaviors to deal with COVID-19 infection. The results of the study demonsrated that the high-levle knowledge on COVID-19 is of most importance in protecting against the PTSD among female college students. Finally, taking the characteristics of college female students into account, we have developed the 10-item perceived threat scale with three dimensions, and its validity has also been confirmed in this research.