In this longitudinal study, we analyzed the tangling interaction effect of family function and coping styles with MHP during and after the stay-at-home period of February to June 2020. The time when college students across China were required to stay at home for a semester and returned to school after the lockdown period ended was an opportunity to study the relationship between these variables.
We found that the incidence rates of depression rose from 33.87% (95% CI, 29.88%--38.10%) to 43.53% (95% CI, 39.08%--48.08%) during the stay-at-home period and dropped to 40.08% (95% CI, 35.76%--44.55%) after students returned to school. The incidence rates of anxiety rose from 17.45% (95% CI, 14.59%--20.73%) to 22.50% (95% CI, 16.94%--23.67%) during the stay-at-home period and kept rising to 26.53% (95% CI, 22.64%--30.82%) after students returned to school. Our results are in line with the recent studies of M Daly, AR Sutin and E Robinson , who state that pronounced and prolonged deterioration in mental health of people occurred during the COVID-19 crisis in UK, and C González-Sanguino, B Ausín, MA Castellanos, J Saiz and M Muñoz , who state that the pandemic has had a negative impact on the mental health of general population in Spain and the mental health of people still does not seem to be at pre-crisis levels even after the country returned to new normality.
The result of interaction effect of family function and time with MHP shows different family function group changes in varying pattern though time: the incidence rates of MHP rose during the stay-at-home period in all family groups, which indicates that none of the family function could not protect the mental health of students from the impact of the pandemic. After students returned to school at T4, the direct influence of family function lessened and interaction with friends and classmates became normal. This change partly explains the reduction in the incidence rates of depression at T4 in HF and MdF groups. However, there was no change in the incidence rates of depression in the SdF group, which indicates a prolonged negative affinity of dysfunctional family function to depression. According to , after most universities and colleges shifted to online study mode during March to June 2020, the academic-related concerns due to pandemic situation have increased, which explains why in our study the incidence rates of anxiety in the HF group increased during T3–T4.
After taking coping styles into consideration, the variance of each subgroup began to emerge. Interestingly, for the passive coping style with HF subgroup, unlike with other subgroups, the incidence rates of MHP tended to reduce during T1–T3 and rise during T3–T4, showing a stronger protective effect of family. However, for the active coping style with SdF subgroup, the incidence rates of MHP tended to rise during T1–T3 and reduce during T3–T4, showing a stronger protective effect of coping style. Additionally, passive coping style with dysfunctional family subgroup had the highest incidence rates of all MHP during T1–T4, indicating that the risk of having MHP was 10 times higher than active coping style with HF subgroup. These results corroborate the findings of previous studies in this field [19, 24].
There are very few studies that consider the relationship between MHP and strong response or weak response coping style. Most of the previous studies using SCSQ have divided participants into only two categories and used the differential value between the standard score of active coping minus the standard score of passive coping to determine the tendency of individual coping styles. If the differential value was greater than 0, it indicated that the individual generally adopted a positive coping style and vice versa . This grouping is arbitrary because the two scores may be very close and an individual may use many coping strategies to overcome difficulties, and therefore we used the method mentioned in Sect. 2.3.3 to differentiate among coping styles. This gave us a chance to investigate the changing pattern of those who reacted strongly to pull through the pandemic and those who reacted weakly. The result is interesting: both groups have lower incidence rates of MHP than the passive coping group, which can be explained by coping styles theorized by Lazarus and Folkman (1984). As explained by Ntoumanis et al. (2009) in their integrated model of stress, coping, and motivation, a strong response coping style is aroused by threat appraisals of the stressor, while a weak response coping style is aroused by benign appraisals of the stressor. However, the change in pattern of these two group in different family function for depression and anxiety are alike and their AOR did not change as drastically as the that of passive coping style, which could be aroused from harm–loss appraisals. According to N Ntoumanis, J Edmunds and JL Duda , effective coping requires a fit between social context, situational appraisals, and choice of coping responses. When variations in actual coping behavior do not result in a “fit” between situational factors and actual coping efforts, one may increase their emotional arousal to a level exceeding that which they can tolerate , and this can explain why MHP show a more stable pattern in the active, strong/weak response coping style group compared with passive coping style.
This study has several advantages: we prospectively followed up a large sample of college students in multiple waves from the first month of the COVID-19 pandemic until the reopening of schools. COVID-19–related MHP depressive symptoms and anxiety were repeatedly assessed with well-established scales. Moreover, the coping style of participants were divided into four categories to get more detailed result. However, our study is not without limitations. First, our sample was collected via convenience sampling methods and may not be fully representative of the general population of college students in China. For example, females constituted a relatively large proportion of the sample, which might limit the generalizability of our results. Second, current mental health disorders were collected by single self-reported items, but no structured or standardized clinical diagnostic interview was used to validate the diagnoses according to DSM or ICD criteria. Third, the coping style was measured at T1 and family function was measured from T2 because the development of the epidemic was not clear in the initial few months. Although SCSQ has high test–retest reliability (0.89) , a lack of repeated measurements could lead to bias in estimates.