Background Due to strict, nationwide, comprehensive COVID-19 protective measures, including home quarantine, all Chinese medical students began taking web-based classes beginning in the spring semester of 2020. Home quarantine, web-based classes, and the stress surrounding the COVID-19 pandemic may have triggered an increased incidence of mental health problems among medical students. Although there have been increasing amounts of literature on depression among medical students, studies focusing on positive psychological resources, such as resilience during the COVID-19 pandemic, still need to be expanded. Objective This study aims to assess depression among medical students who are taking web-based classes during the COVID-19 pandemic and to investigate the role of coping styles as mediators between resilience and depression. Methods A cross-sectional study of 666 medical students involving stratified sampling in Shenyang, Liaoning Province, China, was completed between March 20 and April 10, 2020. The participants responded to a self-administered, smartphone-based questionnaire, which included the Patient Health Questionnaire-9, Simplified Coping Style Questionnaire, and Ego Resilience 89 Scale. Hierarchical linear regression and structural equation modeling were used in this study. Results The prevalence of depression among the participants was 9.6% (64/666) in this study. The regression analysis revealed that grade (the year in which the medical student was in training) (P=.013), how well students adapted to web-based classes (P<.001), their levels of resilience (P=.04), and their coping styles were independent predictors for depression (P<.001). Resilience and positive coping styles were negatively related to depression (resilience: P=.04; positive coping styles: P<.001), and negative coping styles were positively related to depression (P<.001). The structural equation modeling analysis showed that the effect of resilience on depression was partially mediated by coping styles (P=.007). Conclusions In this study, it was found that the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during the COVID-19 pandemic. These findings have significant implications for future studies. Future studies and interventions should aim to improve resilience and promote positive coping styles.

BACKGROUND Due to the strict nationwide COVID-19 comprehensive protective measures, which included home quarantine, all Chinese medical students began taking online classes beginning in the spring semester of 2020. Home quarantine, online classes, and the stress surrounding the COVID-19 pandemic may have triggered increased mental health problems of medical students. Although there has been an increasing literature on depression among medical students, studies focusing on positive psychological resources such as resilience during the COVID-19 pandemic still need to be expanded. OBJECTIVE The present study aims at assessing depression of medical students taking online classes during the COVID-19 pandemic and investigating the role of coping styles as a mediator between resilience and depression. METHODS A cross-sectional study of 666 medical students with stratified sampling in Shenyang, Liaoning Province in China was completed between March 20th, 2020 and April 10th, 2020. The participants responded to a self-administered smartphone-based questionnaire which included Patient Health Questionnaire (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), and Ego-Resilience scale (ER-89). Hierarchical linear regression and structural equation modeling (SEM) were used in this study. RESULTS The prevalence of depression in the participants was 9.6% in this study. Regression analysis revealed that grade (the year in which the medical student was in their training), how well they adapted to online classes, their levels of resilience, and their coping styles were independent predictors for depression. Resilience and positive coping style were negatively related to depression and negative coping style was positively related to depression. SEM showed that the effect of resilience on depression was partially mediated by coping styles. CONCLUSIONS It was found in the present study the prevalence of depression was slightly low and coping styles mediated the association between resilience and depression among medical students during COVID-19, which was of significant implications for further study. Future studies and interventions are supposed to be aimed at improving resilience and promoting positive coping style.