Study procedure
The target population comprised of international students from Central South University including undergraduates, Master's degree/postgraduate students, and Ph.D./doctoral students. The questionnaire was comprised of questions on demographic information, gender, grade year, duration and status of quarantine, duration of sleep, worries about graduation, being able to go to school, and the presence or absence of a sense of security.
The data was collected from students who have been unable to go to school since the COVID-19 outbreak, from January 25, 2020, to June 26, 2020. The survey was completed on the Chinese Star Survey website between 19th to 26th June, with the relevant smartphone link sent to the Xiangya WeChat international students group. These students were informed about the motive of the survey i.e to comprehend the effects of the COVID-19 epidemic on the mental health of international students.
Depression
Depression was assessed using the 9-item Patient Health Questionnaire-9 (PHQ-9), which is sensitive and specific, sufficient to screen adolescents with suspected depression.[10] Furthermore, the PHQ-9 is the most regularly used device designed for screening depression in primary care [11][12], [13], and is a 9-item depression module from the full PHQ. The participants were requested to respond to the questions to consider the frequency of the specific symptoms that they felt during the quarantine period. The solutions were scored as follows: zero(0) point for not at all, one(1) point for several days, two(2) points for more than half of the days, and three(3) points for nearly every day. The score was scaled from 0–27 (0–4: without depressive symptoms, 5–9: with mild depression symptoms, 10–14: with moderate depression symptoms, 15–19: with moderate to severe depression symptoms, and 20–27: with severe depression symptoms) [11]. This scale has additionally been broadly used with Chinese populations and has validated brilliant psychometric properties [14].
Anxiety
Anxiety was assessed by the usage of the 7-item Generalized Anxiety Disorder-7 (GAD-7) scale, which has been used to consider the mental health status of people after the MERS outbreak [15]. The GAD-7 scale contains seven noticeably applicable questions chosen from 13 items (nine questions from the Diagnostic and Statistical Manual of Mental Disorder, 4th Edition, and four questions from the Anxiety Symptom Scale). For every item, the participants were asked about their frequency of experiencing each one of the emotions at some stage during their quarantine period for COVID-19. The answers were scored as follows: zero (0) point for not at all, one (1) point for several days, two(2) points for more than half of the days, and three(3) points for nearly every day. The score was scaled from 0–21 (0–4: without anxiety symptoms, 5–9: with mild anxiety symptoms, 10–14: with moderate anxiety symptoms, and 15–21: with severe anxiety symptoms) [15].
To figure out if STAI-Y2 TRAIT scores can be a predictive factor of depression or anxiety, all participants have been assessed with the State-Trait Anxiety Inventory (STAI). The STAI-Y consists of 40 self-report items, for both state and trait components. STAI-Y items are rated on a 4-point Likert scale. (STAI-Y1STATE) report the extent of their anxiety at particular moments, while (STAI-Y2TRAIT) indicate the intensity of their anxiety in general: both scores were computed in this study. Scores of each state- and trait-anxiety range from 20 to 80, a higher score indicating greater anxiety. [16]
Quarantine
Students who lived in the dormitory have been in quarantine since January 25 which is still ongoing as of July 7 until further notice. Hence, they have been in quarantine for about 6 months now. Quarantine period was determined by the question: “How much time on average have you spent in quarantine from the outside since the COVID-19 outbreak and are you still in quarantine now?” According to the duration, participants were categorized into 5 groups: None, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months. According to the current situation, participants were categorized into two groups: still in quarantine and not in quarantine.
Sleep duration
Sleep length was determined by the question: “How much sleep you had on average every night over the past four weeks?” The participants were categorized into six groups based on their reported average sleep duration: <6 hours/night, ≥ 6 to < 7 hours/night, ≥ 7 to < 8 hours/night, ≥ 8 to < 9 hours/night, ≥ 9 to < 10 and ≥ 10 hours/night [17] with < 6 hours/night being seen as short sleep duration.[18]
Degree of worrying about graduation
The degree of worrying about graduation was determined from the question: “how much do you worry about graduation?” Participants were categorized into 4 groups: Not at all, a little, somewhat, and very much.
School Time
To be able to go to school was determined by the question: ”Can you go back to school/hospital to study now?” If you can, how long? Participants were categorized into 2 groups: Not at all, sometimes.
Sense of security
The presence or absence of a sense of security was determined by the question: ”do u feel secure?” Participants were categorized into 4 groups: Not at all, a little, somewhat, and very.
Ethical approval and consent
The participants were informed that the motive of the survey was to comprehend the psychological effects of the COVID-19 epidemic on students and was conducted via an online WeChat notification before the investigation. Students who were willing to participate in the survey filled out the questionnaires. Online informed written consent was obtained from all participants at the beginning of the questionnaire. The present study was approved by the Medical Ethics Committee of Second Xiangya Hospital of Central South University (2020) of the National Examination Bureau Number (001)
Statistical Analysis
All statistical analyses were performed using the IBM SPSS Statistical Software (version 22). Counting data was presented in counts (the percentage of the total). The chi-square test was used to determine whether there were significant differences between the number of asymptomatic and symptomatic students, in terms of different genders, grade year, duration and status of quarantine, duration of sleep, worries about graduation, being able to go to school and presence or absence of a sense of security. The Kruskal-Wallis test was used to determine whether there were significant differences among the number of symptomatic (in varying degrees) students, in terms of different gender, grade year, duration and status of quarantine, duration of sleep, worries about graduation, being able to go to school and presence or absence of a sense of security. One-way ANOVA and t-test calculations were used to assess the differences in the State-Trait Anxiety between the subgroups which were stratified by different gender, grade year, duration and status of quarantine, duration of sleep, worries about graduation, being able to go to school and presence or absence of a sense of security. A P-value of < 0.05 was considered statistically significant.