An Analysis of the Influence of Novel Coronavirus Pneumonia Epidemic on Middle School Students' Mental Health

Objective: To explore the psychological health status of middle school students in China during the recent epidemic outbreak of “Novel Coronavirus Pneumonia” (NCP) and its influencing factors, and to provide a basis and suggestions for the adjustment of mental health of middle school students during the epidemic. Methods: A total of 2,007 middle school students were randomly selected nationwide to fill out a questionnaire. The questionnaire included basic personal and family information, life status and family relations during the epidemic, attitudes and pressures in the face of the epidemic, created by Chinese professor Zung. The anxiety self-assessment scale (SAS) compiled by SPSS statistical analysis software was used for data analysis to explore the changes in mental health during the epidemic. Results: Of the 2,007 valid questionnaires, according to the data using the self-rating anxiety scale, 424 students had anxiety, accounting for 21.1% of the total number; anxiety level of boys was higher than that of girls, and the anxiety level increased as the grade level increased. The student's personality, grade level, problem-solving methods, awareness and attention to the epidemic, parents' educational background, marital status, and family economic status all had an impact on the student's psychological status during the epidemic. Conclusion: The Novel Coronavirus Pneumonia epidemic has a great impact on the mental health of some middle school students. Family, school and social departments should pay attention to this phenomenon, care for their mental health, and take reasonable measures to actively intervene.

occurred in Wuhan. Subsequently, infections were found in Thailand, Japan, South Korea, and other provinces in mainland China, and the number of infections expanded rapidly. By the end of January 2020, all 31 provinces in mainland China had initiated the highest level of response procedures for major public health incidents. Productivity and daily routines of people across the country and the schooling of all students basically came to a halt. On February 11, the World Health Organization (WHO) assigned its English name Corona Virus Disease 2019 (COVID- 19), which shows that a world-class infectious disease had begun.
In response to the outbreak of the novel coronavirus pneumonia epidemic, China has adopted many strict prevention and control measures. The implementation of nationwide home isolation, large -scale nucleic acid testing and epidemiological investigations, business closures, factory shutdowns, and suspension of in-class teaching have brought about a near-isolated living condition that poses challenges to the lives and physical and mental health of most people. Facing the possible psychological crisis in society during the epidemic, the National Health Commission issued the "Guiding Principles for Emergency Psychological Crisis Intervention of Pneumonia with Novel coronavirus Infection" on January 26, 2020 [8]. The overall deployment of the measure provided mental health services for different groups of people. Next, various departments and social organizations in various regions began to actively participate in the mental hea lth counseling work of the people.
Affected by this major public health emergency, the extended suspension of classes, and holidays spent in isolation will change the physical and mental health of middle school students, and how they respond to the spread of the epidemic. The possible crisis of life and study is the main focus of this study. Based on this, this paper conducts a sample survey on 2 ,007 middle school students nationwide to understand the real situation of life, study and mental health of middl e school students during the epidemic, hoping to find problems in time and provide reliable psychological intervention basis for them.

General Information Questionnaire
The content of the general information questionnaire involves basic information such as the individual's gender, age, grade level, place of residence, family size, family economic situation, family relationship, study time, exercise time, leisure time, and knowledge of Novel Coronavirus Pneumonia.

Self-Rating Anxiety Scale (SAS)
The self-assessment scale of SAS anxiety prepared by Chinese-American professor Zung (1971) is mainly used for screening or assisting in evaluating the anxiety behavior of the respondents and the severity of anxiety [9]. There are 20 items in the scale, and the main statistical indicator is the total score. Totaling the scores of the 20 items results in a raw score. Multiplying the raw score by 1.25 and keeping the integer part results in the standard score. According to the results of the Chinese norm, the cut-off value of the SAS standard score is 50 points, of which 50-59 points indicate mild anxiety; 60-69 points indicate moderate anxiety; more than 70 points indicate severe anxiety. The Cronbach alpha coefficient of the scale is 0.888.

Self-assessment
The content of this part of the questionnaire is divided into four factor categories to investigate the students' living conditions and personal feelings during the epidemic. The scale was written and designed on the basis of the Likert scale improved by the American social psychologist Likert in 1932 on the basis of the original total a ddition scale [10]. The scale has a total of 18 items and consists of a set of statements. Each statement has five answers: "strongly agree", "agree", "not necessarily", "disagree", and "strongly disagree", which are divided into 5, 4, 3, 2, and 1. The total score of each respondent's agreement is the total sum of the scores of his answers to each question. This total score can indicate that his agreement is strong or that he is on this scale different situations. The Cronbach alpha coefficient of the scale is 0.864. In March 2020, the middle school students in 23 provinces were selected through the Internet to fill out the questionnaire. In the end, a total of 2,058 questionnaires were received, 51 invalid questionnaires were screened out, and 2007 va lid questionnaires were retained. The questionnaire efficiency was 97.5%. The top regions in the questionnaire are mainly Guangdong (42.13%), Shandong (24.39%), Hainan (12.54%), Anhui (6.56%), Henan (5.34%), Sichuan (2.28%), Shanxi (2.09%), Guangxi (1.21%), Hubei (1.02%) and remainder other provinces.

Implementation procedures
Through the Wenjuanxing (a platform providing functions equivalent to Amazon Mechanical Turk) , a questionnaire was prepared, and after a number of test feedback and improvements, the final questionnaire was formed. Afterwards, the snowball sampling of questionnaire is carried out through WeChat, friends circle, QQ, etc. The 1 st year middle school students to the 3 rd year students will answer the survey one time anonymously. Multiple submissions of the data are considered invalid.

Statistical methods
In this study, SPSS 22.0 statistical software was used for data analysis. The count data was expressed as a percentage (%), and the measurement data was expressed as mean x ± s. The comparison between groups was performed by χ2 test and F test.
Multiple regression analysis was used.

Summary and breakdown of the research subjects
The effective number of participants in the questionnaire survey is 2,007, aged between 11 and 20 years, with an average age of 14.95 ± 1.85 years. For summary and breakdown, see Table 1. information sources are WeChat, Weibo, short videos and other online media, accounting for 84.21%; followed by TV news, accounting for 73.64%, and obtaining information through parents or family members, accounting for 50.82%.

Middle school students' feelings during the epidemic
Through the self-made Likert scale, the 20 questions answered by individuals during the epidemic were classified into 4 factors by factor analysis, which are positive future outlook, academic worries, life worries and negative feelings ( Table 2 and Table   3). Comparison of scores of different factors between different genders: Among the four types of factors, the positive future outlook of girls is higher than that of boys, and the negative feeling of boys is higher than that of girls, the differences are significant (P <0.005). For academic worry and life score, the difference was not significant (P> 0.005).

Statement
Comparison of the scores of various factors between different grade levels: The academic concerns of 3 rd year students are significantly higher than those of 1 st and 2 nd year students, the difference is extremely significant (P <0.001), but there is no significant difference between the two in negative feelings, life worries and positive future outlook (P> 0.005).
Comparing the scores of various factors in different living areas: County-level cities and township students have significant differences with provincial capital cities and prefecture-level cities in all four factors (P <0.005), and are higher than the latter.
Comparing the scores of various factors among parents with different educational backgrounds: Students with parents whose educational background is junior high school and below are significantly different from other classmates in life and academic concerns (P <0.005), and the average value is the highest.
Comparing the scores of various factors of the students' parents' marital relationships: students with stable parents' marital relationships have significantly lower negative feelings and academic concerns than other students, and have higher scores on positive future outlook with significant differences (P <0.005).
Comparing of the scores of various factors between different families' economic levels: the economic level and the four factors are significantly different (P <0.005). Students in poverty households have the highest scores on negative feelings, and the students in poverty households are worried about life and positive expectations. Wealthy families score the highest, and the economically wealthy students have the highest scores on academic concerns.

Sources of stress among middle school students
In the design of the questionnaire, the sources of stress experienced by the students are selected on a scale of 1-10, and a score of more than 5 points is considered to have a greater impact on the stude nt during the epidemic. The main sources of stress over 5 points are academic performance, online learning methods, changes in learning environment, novel coronavirus pneumonia virus, parental control, and limited social activities (

2.809
The scores of middle school students' anxiety scale (SAS) Through the statistical calculation of the 2,007 questionnaires, the anxiety self-assessment scale was divided into 42.23 ± 11.39, and the method of demarcation was established according to X ± SD, that is, when the SAS standard score ≥ x + SD = 40.65 + 9.47 indicated a state of mild anxiety, and when the standard score ≥ X + 2SD = 40.65 + 2 × 9.47, indicated a state of moderate or severe anxiety. With a total score greater than 50 as the dividing line, it was found th at 424 (21.1%) of the 2,007 students were in a state anxiety, of which 260 students were in a mild state of anxiety, 107 students were in a moderate state of anxiety, and 57 students In a severe state of anxiety. Among the students in a state of anxiety, there are 216 boys and 208 girls, and the average anxiety value of boys (42.53 ± 11.82) is slightly higher than that of girls (41.96 ± 10. 96). At the same time, an increases in grade level, students' anxiety scores showed an upward trend.

Single factor difference analysis of middle school students' anxiety score
Taking anxiety as a dependent variable, we analyzed the grade levels, social support channels, stress index, positive future outlook, academic worries and negative feelings of middle school students and the situation of children in middle school student's families and their families' economic status. Positive future outlook are negatively correlated (P <0.01), and other variables are positively correlated with anxiety (children's' situation P <0.05, other P <0.01) ( Table 5).

Analysis of factors affecting middle school students' anxiety during the new crown epidemic
Taking the total score of SAS anxiety as the dependent variable and using multiple stepwise regression analysis to explore the relevant factors affecting the anxiety level of middle school students, it was found that anxiety and students' grade level, personality, social support channels, positive future outlook, academic worries and negative feelings result in significant differences (P <0.05 for personality, P <0.01 for other variables), results in Table 6.

Factors affecting the mental health of middle school students during the NCP epidemic
Anxiety exists in all kinds of situations, including quality anxiety and general anxious emotional responses in healthy people.
Moderate anxiety can arouse alertness and improve learning and work efficiency. But adolescents are in a developing stage of body and mind. If pressures from the external environment and the confusion in their own growth are not dealt in a timely fashion and with appropriate psychological guidance, it will lead to the emergence of high anxiety [11]. The detection rate of anxiety among Chinese teenagers is 7% ~ 16% [12]- [13], and the results of this study show that the detection rate of anxiety is 21.1%, which is significantly higher than the detection rate of anxiety among adolescents in normal times, and some students are in a state of moderate to severe anxiety. It shows that during the period of home isolation, most middle school students have relatively stable emotions, but some middle school students have different levels of negative emotions. In order to control the spread of the NCP epidemic, work stoppages and school closures have been implemented nationwide, and home isolation measures have also prevented students from returning to school on a normal basis. From the perspective of students ' personal feelings, students' worry about their own learning, negative feelings of the epidemic and future outlook of life will have an impact on anxiety. The more worried students are about learning, the more negative feelings and the lower future outlook, the higher the likelihood of students having anxiety. In terms of grade level, the anxiety level of students in 3 rd year higher than that in 1 st and 2 nd year. Under the influence of the epidemic, students cannot return to school for review on time. Plus the midterm and college entrance examinations are imminent, so that 3 rd year students in the preparation state are subject to greater academic pressure and more anxiety. From the perspective of personality, there is a negative correlation between student personality and anxiety. In comparing the anxiety levels of students with different personalities, it is found that students with introvert personalities have higher anxiety level than students with intermediate and extrovert personalities. There is a negative correlation between anxiety levels, indicating that the more cheerful an individual's personality, the lower the probability of anxiety. Some studies have also found that introvert students are more likely to produce negative emotions and have a lower subjective well-being. These characteristics determine that the mental health level of introvert students is significantly lower than that of extroverted students [14], and needs more attention during the epidemic. Students with introvert personality tend to be alone, not good at sharing their inner emotions with others, and are used to being stressed alone. The long-term existence of negative emotions such as anxiety and depression will not only affect the ir physical and mental health, but also affect and change the personality of the individual and affect their adulthood mental health [15]. In addition, their family economic status is related to the mental health of middle school students, which is consistent with previous studies [16]. Middle school students from wealthy and upper middle class families have a healthier family mental state, while students from lower and middle class families have a higher level of anxiety. Because of the NCP epidemic, almost all aspects of life are affected, life is no longer normal, which may cause some families to fall into a temporary family economic crisis. Middle school students' concerns about their own family economic problems are also likely to increase their inner pressure and anxiety. Finally, students' social su pport channels will also affect anxiety. Middle school students who are not good at asking for resources around them and cannot get social support, are more likely to experience anxiety [17].

The mental health of special groups among middle school students requires special attention and active intervention
This study measured 2,007 middle school students and found that during the outbreak, the SAS standard score was 42.53 ± 11.82 for boys and 41.96 ± 10.96 for girls, which was significantly higher than the survey data of Zhang Yuanyuan and Jing Pan on the anxiety of middle school students in Ningbo in 2015 34.82 ± 6.86, female: 35.07 ± 7.17) [18]. It shows that the psychology of the middle school students group is indeed affected by the stress NCP epidemic, which produces anxiety higher than usual. Therefore, it is necessary to take active measures to help students adjust mentally, especially for the introverted students, the freshmen, the disharmonious family relationship and the poor family economy. For example, the opening of online psychological counseling services and psychological adjustment courses for middle school students can help them correctly recognize their emotions and relieve psychological pressure. At present, some regions, social organizations and academic groups have opened free psychological counseling services, such as the "Qingqing Hotline" of South China Normal University, the psychological counseling service hotline and network counseling service of Beijing Normal University, and the crisis response mechanism for minors established in Changsha. Psychological crisis intervention team during the epidemic situation and so on. We should also actively use news media and online channels to achieve social support of social information and resources for families and students, open up communication channels for students, families, schools, and society, and achieve effective information transmission and resource sharing [19]. Schools can conduct periodic psychological health surveys on students by issuing questionnaires to keep abreast of the student s 'psychological status and their family situation. The interference of anxiety on the daily lives of children and adolescents is the main motivation for seeking psychological counseling and treatment [20], providing one-on-one online psychological counseling and difficulty assistance to students with anxiety symptoms. Especially for junior and senior students in the third grade, professional psychotherapists can also organize online mental health meetings for students, impart relevant psychological knowledge, prevent students' psychological problems, and help students improve self-regulation and problem coping ability. The community should play an active role in difficult investigation and family relationship mediation. Due to the inconvenience during the e pidemic, some families have difficulties in life, and there are more contradictions in the family parent-child relationship or marriage relationship. At this time, the neighborhood committee and community service staff should actively investigate, provide timely material assistance and mental adjustment support, and help normalize their family life and family relations during the epidemic.

Guide middle school students to arrange their life scientifically and maintain interpersonal communication during the epidemic
Due to the epidemic, all students were isolated at home, lacking outside contact. Middle school students are young and have poor self-control, but they end up setting their own schedule for study, sports and leisure time during the epidemic while the daily routine of the entire family is not as regular as usual. Therefore, in the public med ia, in the connection between school and the family and students, should actively promote and give guidance for a reasonable daily routine and other time management, as maintaining a normal daily routine can be conducive to mental health [21]. For example, students can adjust school schedules and rest schedules for their own use. The family can set a schedule for rest and relaxation, allocates leisure and leisure time, develop family activities that family members can participate in, strengthen parent-child relationships, or learn together. In addition, it is necessary to maintain communication with the o utside world using online programs. Schools can arrange and organize regular online class meetings through WeChat, QQ, and other online programs. They can ask students to share and exchange their own living situations and learning arrangements to help other students. We can encourage contact and communication with other students and teachers to express emotions and reduce psychological pressure.

Improve students' awareness of the epidemic and create a family and social environment that unites and fights against the epidemic
Due to the epidemic, the time students spend with their parents at home has greatly increased. Middle school students are in adolescence and rebellion, and the contact time between the two increases. In addition to paying attention to the emotions of students, the emotions of parents and other family members should also be valued. Both parties should pay attention to maintaining a good family environment and parent-child relationship. The Barratt study found that the anxiety of children and adolescents is related to the quality of parental relationships. The higher the level of conflict in parental relationships, the higher the level of child anxiety [22]. It is an important goal of child anxiety treatment [23]. Therefore, the parents' marital relationship and behavior at home will always affect the child's psychological state. A positive state will encourage the child to actively deal with external pressure, while a negative parental or family environment will increase the child's anxiety. Communities, schools, and social welfare organizations can all participate in family education, provide family charity lectures and counseling, encourage and educate parents and adolescent children to live in harmony, enhance family cohesion, and enhance family resilience. At the same time, the information propaganda of the news media should take into account the acceptance and understanding capabilities of different audiences, especially since the flood of media has resulted in a mix of true and false information, which is difficult to distinguish. Middle school students have poor self-identification ability and are easily misled by incorrect information. Therefore, families and schools should pay more attention to reports in mainstream media and not promote rumors. They should promptly dispel rumors and propagate scientific anti-epidemic measures through schools, communities, and public platforms, and convey correct social information to middle school students in a concise and easy-tounderstand manner, so that middle school students have confidence in our country 's anti-epidemic situation and overcome this battle with us.

Conclsion
This study shows that in the social disaster event, China should establish a social mental health emergency counseling mechanism. Especially for the vulnerable groups, such as middle school students and the students in the stage of entering school, help them to maintain a reasonable life and life to deal with the mutation, and avoid the psychological trauma to the future growth.