Emotional problems are the most common psychological symptoms in university students , which may further increase during public health emergencies . This large-scale, cross-sectional, epidemiological, online study focused on evaluating depressive and anxiety symptoms of university students during the COVID-19 pandemic and explored possible related factors influencing them. This survey indicated three main findings. Firstly, among university students in mainland China, 37.0% experienced depressive symptoms, 24.9% experienced anxiety symptoms, and 20.9% experienced comorbidity depressive and anxiety symptoms. Secondly, the female gender, being a graduate, and personal COVID-19 exposure were independent risk factors and living with family was an independent protective factor for developing depressive and anxiety symptoms. Thirdly, depressive and anxiety symptoms are negatively associated with the level of awareness of COVID-19.
Currently, there is no data on the prevalence of depressive symptoms in university students during the COVID-19 pandemic. Available data on the prevalence of anxiety symptoms was from a study conducted at a single medical university, which showed similar results to this study . In general, the prevalence of depressive and anxiety symptoms demonstrated in this study is clearly much higher than in most previous studies during non-pandemic periods. For example, a meta-analysis, involving 39 studies with 32694 Chinese university students, indicated that the prevalence of depressive symptoms was 23.8% (95% CI: 19.9–28.5%) . In the case of anxiety symptoms, 10% of university and graduate students reported significant anxiety symptoms at some time during their school years [29, 31]. However, a relatively high prevalence of depressive and anxiety symptoms has also been observed in individual studies . On further analysis of the severity of mental health problems, it was found that mild depressive and anxiety symptoms were most common. In addition to anxiety and depression symptoms, college students' suicidal ideation during the COVID-19 epidemic should also be concerned. Studies have shown that during the COVID-19 epidemic, the public has a high rate of suicidal ideation due to factors such as unemployment, home isolation, anxiety, depression, and insomnia symptoms [10, 33, 34]. But there have been no studies of college students. So it is worth mentioning that, even though only 7.3% students had suicide ideation, more attention should be paid to students with these characteristics.
There is now sufficient evidence to state that the female gender is a reliable risk factor for depressive and anxiety symptoms [5, 17, 32, 35]. The gender difference was verified in our study. But our study found female students is a protect factor for suicidal ideation, This is consistent with previous research on factors influencing suicide ideation among Chinese college students, it may be related to the great pressure placed on male college students by Chinese society . Graduate students, in contrast to undergraduate ones, have more negative emotions. This might be explained by more profound stresses regarding economic, marital, academic, interpersonal, and employment concerns as a result of the pandemic. Although graduate students had more negative emotions, they had less suicidal ideation than undergraduates, this is not consistent with previous studies. Studies have shown that in the student population, for those older than 25 years old students, the suicide rate of students is significantly higher than that of students younger than 25 years old in college students. In the group of students aged 20 to 24, suicide rate of graduate students is higher than that of undergraduate students [37, 38]. In the present study, students living with family are related to lower risk of mental health problems, lower percentage of suicidal ideation. Some authors have demonstrated that family support, especially parental support, is very important and could effectively buffer the effects of high stress on anxiety symptoms and depressive symptoms, it also reduces suicidal ideation [39–42]. Conversely, the emotional loneliness resulting from being cut off from one’s family is the strongest variable related to issues in mental health . As predicted, COVID-19 exposure is closely related to bad moods. Individuals who were quarantined, irrespective of their wishes, suffered from isolation and directly faced the problems of infection, medical treatment, and even death [44, 45].
Good knowledge regarding infectious diseases may assist in the prevention of psychological problems . More accurate COVID-19 knowledge significantly produced a lower likelihood of negative attitudes and potentially dangerous practices towards the pandemic , and reduced fear and panic . Our findings supported this view and revealed COVID-19 knowledge as an independent protective factor for mental health among university students. Of course, it is important to provide specific up-to-date and accurate health information (e.g., treatment, local outbreak situation) about the outbreak . Since the early stage of the COVID-19 pandemic, the Chinese government has provided essential COVID-19 knowledge to the public, every day, through media campaigns via television, radio, WeChat, Tik Tok and newspapers. However, it was found that only 42.1% students were familiar and 15.5% were unfamiliar with COVID-19 knowledge. Therefore, public health policy makers and health workers should recognize this target population for COVID-19 prevention training and health education.
Based on the pandemic characteristics of COVID-19, the Chinese government and public authorities made efforts to facilitate the implementation of pandemic prevention measures. The practices were very cautious in the Chinese population: decreased unnecessary outings, avoiding crowded places, wearing masks when going outside, and washing hands frequently . Consistent with this, 87.0% students had taken all the prevention and control measures against COVID-19 to avoid infection in the current study. Moreover, our study results were in agreement with a previous study, which suggested that precautionary measures could reduce the psychological impact of the outbreak and levels of anxiety and depression [49–51]. According to this data, it is necessary to carry out targeted prevention and control measures and allocate health resources effectively.
During this survey period, the number of reported infection cases nationwide began to decline slightly, but the pandemic was spreading rapidly around the world and some imported cases occurred. Therefore, the public was urged to take more stringent preventive and control measures. Almost all students continued to stop their university studies and practice, and their range of activities was greatly restricted, which caused great inconvenience in their lives. Psychologically, when the living environment changes, people feel unsafe, uneasy, and anxious . Long-term self-isolation can make people bored and prone to focus too much on negative pandemic information, which also increases the risk of mental health problems . However, our finding that the majority of students had an optimistic attitude about overcoming this crisis was unexpected. The most likely explanation for this situation is due to the openness and transparency of data and the effective and standardized implementation of prevention and control work in China . The optimistic attitude towards the prospects of COVID-19 could reduce depressive and anxiety symptoms because risk perception has a greater correlation with mental health . Recently, the government actively promoted the resumption of work, production and education , which will further positively impact on mental health.
The key strengths of this study included the wide-ranging demographics and having the largest sample studied to date. In addition, it was the first study to investigate the prevalence of mental health among university students and its influence. However, there are also some limitations to this study. First, the study adopted the method of convenience sampling to recruit subjects, which may lead to a lack of sample representativeness and an imbalance of the sample distribution. Second, reporting bias may exist due to the nature of self-reported data, which may not always be consistent with the evaluation of mental health professionals. Third, all the data were collected in a cross-sectional survey, and therefore, causal relationships could not be established. Finally, the item 9 of PHQ-9 was mainly used for the evaluation of suicide ideation. No professional questionnaire is used for the evaluation of suicide ideation, which may not be systematic and detailed enough.
In conclusion, the mental health status of university students has been affected during the COVID-19 pandemic, with a high prevalence of depressive and anxiety symptoms, suicidal ideation. The female gender, graduates, living with family, personal COVID-19 exposure and awareness of COVID-19 were related factors for depressive and anxiety symptoms. Although various psychological health services have been provided by the Chinese government through various channels, such as hotlines, online consultation and outpatient consultation , it is necessary to pay more attention to mental health among university students while combating COVID-19, and to early intervention regarding their psychological problems. In addition, our study showed that anxiety and depression symptoms are important risk factors for suicidal ideation. While paying attention to the anxiety and depression symptoms of university students, we should also pay attention to the students' suicidal ideation, and focus on the intervention of students with suicidal ideation.