Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study

Abstract

Background The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. Objective This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. Methods A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. Results Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). Conclusions Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic.

A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: a call to action

“…There were 16 studies from Africa [ 14 , 24 , 59 , 68 – 73 , 75 – 79 , 84 , 88 ], 25 studies from Asia [ 22 , 60 , 61 , 64 – 66 , 74 , 80 , 81 , 83 , 86 , 87 , 90 – 95 , 97 – 99 , 101 , 102 , 104 , 105 ], and others were conducted in Europe [ 67 , 89 , 96 ], North America [ 62 , 63 , 85 , 100 , 103 ] and South America [ 82 ]. More than half (27 studies) of the studies were conducted within community populations [ 22 , 60 , 66 , 69 – 72 , 74 , 76 , 79 – 81 , 83 , 85 – 88 , 90 , 91 , 93 , 95 , 99 – 104 ], while others consisted of health care workers (13 studies) [ 60 , 61 , 63 , 64 , 67 , 77 , 78 , 84 , 89 , 92 , 94 , 96 , 105 ] and patients (eight studies) [ 14 , …”

“…More than half (27 studies) of the studies were conducted within community populations [ 22 , 60 , 66 , 69 – 72 , 74 , 76 , 79 – 81 , 83 , 85 – 88 , 90 , 91 , 93 , 95 , 99 – 104 ], while others consisted of health care workers (13 studies) [ 60 , 61 , 63 , 64 , 67 , 77 , 78 , 84 , 89 , 92 , 94 , 96 , 105 ] and patients (eight studies) [ 14 , 24 , 59 , 68 , 73 , 75 , 97 , 98 ]. Of the 50 articles, 10 studies [ 24 , 59 , 73 , 75 , 80 , 82 , 85 , 91 , 97 , 105 ] used modified scales for measuring stigma, while other studies measured the stigma by using one or more questions [ 14 , 22 , 60 – 72 , 74 , 76 – 79 , 81 , 83 , 84 , 86 – 90 , 92 – 96 , 98 – 104 ] (Table 1 ).…”

“…(3) Would you touch someone who has recovered from Ebola? Wang et al, 2021 [ 102 ] China Cross sectional COVID-19 Enacted stigma 4191 4191 Community population 61.0 62.0 Items: Public discrimination against COVID-19 cases Wei et al, 2020 [ 87 ] China cross sectional COVID-19 Perceived stigma 1344 1344 Community population 60.1 57.4 Items: Reporting makes me feel stigma Yohannes et al, 2020 [ 76 ] Ethiopia Cross sectional COVID-19 Enacted stigma 247 247 Community population 23.5 83.8 Items: I felt that COVID-19 was a stigmatized disease Yu et al, 2020 [ 103 ] United States Cross sectional COVID-19 Perceived stigma 235 235 Community population 47.9 7.6* Items: Experience of discrimination: adapted from the Everyday Discrimination Scale Responses were averaged to indicate the overall experiences of discrimination participants perceived: (1) you are treated with less courtesy or respect than other people; (2) people act as if they think you are dangerous Yu et al, 2021 [ 104 ] China Cross sectional COVID-19 Perceived stigma 23863 23863 Community population 68.1 58.1 Items: Perceived discrimination due to COVID-19 Yufika et al, 2021 [ 105 ] Indonesia Cross sectional COVID-19 Enacted stigma 288 288 Health care workers 65.3 21.9 Scale: A six-item questionnaire [*Note]: S...…”

Using Multimodal Assessments to Capture Personalized Contexts of College Student Well-being in 2020: Case Study

“…All of the aforementioned health-related concerns for college student mental health have been exacerbated by the COVID-19 pandemic [ 33 , 34 ]; universities across the states have converted into remote learning centers, sending college students home, disrupting their previous routines and daily rhythms, upending job prospects and the economy, and increasing uncertainty and anxiety across the United States [ 35 - 39 ]. Altogether, a tremendous shift has occurred from the excitement and opportunities of collegiate life to turbulence, trauma, and stress, relating to increased rates of mental health problems in this population [ 40 - 43 ]. The uncertainty with the ongoing pandemic renders many of the stabilizing factors in the college experience even harder to attain; therefore, there may be added stressors in maintaining social support networks and uncertainties with financial support for current college students, as well as worries about the quality of one’s education and career prospects for students close to finishing their degree.…”

“…Our purpose is to thus incorporate these multimodal assessments together in studies examining contexts. As prior studies have documented evidence of the negative associations of the pandemic among college students [ 33 , 34 , 40 - 43 ], capturing daily life during the pandemic, shelter-in-place orders, social distancing, and remote learning among college students may help to better understand the individualized increased risks for student mental health. In turn, this may ultimately further expand our understanding of the pandemic experience and its association with college student well-being.…”