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      Prevalence and Psychosocial Correlates of Mental Health Outcomes Among Chinese College Students During the Coronavirus Disease (COVID-19) Pandemic

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          To investigate the prevalence and risk factors for poor mental health of Chinese university students during the Corona Virus Disease 2019 (COVID-19) pandemic.


          Chinese nation-wide on-line cross-sectional survey on university students, collected between February 12 th and 17 th, 2020. Primary outcome was prevalence of clinically-relevant posttraumatic stress disorder symptoms. Secondary outcomes on poor mental health included prevalence of clinically-relevant anxiety and depressive symptoms, while posttraumatic growth was considered as indicator of effective coping reaction.


          Of 2,500 invited Chinese university students, 2,038 completed the survey. Prevalence of clinically-relevant PTSD, anxiety, and depressive symptoms, and post traumatic growth (PTG) was 30.8, 15.5, 23.3, and 66.9% respectively. Older age, knowing people who had been isolated, more ACEs, higher level of anxious attachment, and lower level of resilience all predicted primary outcome (all p < 0.01).


          A significant proportion of young adults exhibit clinically relevant posttraumatic stress disorder (PTSD), anxious or depressive symptoms, but a larger portion of individuals showed to effectively cope with COVID-19 pandemic. Interventions promoting resilience should be provided, even remotely, to those subjects with specific risk factors to develop poor mental health during COVID-19 or other pandemics with social isolation.

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          Most cited references 35

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          The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction.

          Childhood abuse and other adverse childhood experiences (ACEs) have historically been studied individually, and relatively little is known about the co-occurrence of these events. The purpose of this study is to examine the degree to which ACEs co-occur as well as the nature of their co-occurrence. We used data from 8,629 adult members of a health plan who completed a survey about 10 ACEs which included: childhood abuse (emotional, physical, and sexual), neglect (emotional and physical), witnessing domestic violence, parental marital discord, and living with substance abusing, mentally ill, or criminal household members. The bivariate relationship between each of these 10 ACEs was assessed, and multivariate linear regression models were used to describe the interrelatedness of ACEs after adjusting for demographic factors. Two-thirds of participants reported at least one ACE; 81%-98% of respondents who had experienced one ACE reported at least one additional ACE (median: 87%). The presence of one ACE significantly increased the prevalence of having additional ACEs, elevating the adjusted odds by 2 to 17.7 times (median: 2.8). The observed number of respondents with high ACE scores was notably higher than the expected number under the assumption of independence of ACEs (p <.0001), confirming the statistical interrelatedness of ACEs. The study provides strong evidence that ACEs are interrelated rather than occurring independently. Therefore, collecting information about exposure to other ACEs is advisable for studies that focus on the consequences of a specific ACE. Assessment of multiple ACEs allows for the potential assessment of a graded relationship between these childhood exposures and health and social outcomes.
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            Resilience and mental health.

            The relationship between disease and good health has received relatively little attention in mental health. Resilience can be viewed as a defence mechanism, which enables people to thrive in the face of adversity and improving resilience may be an important target for treatment and prophylaxis. Though resilience is a widely-used concept, studies vary substantially in their definition, and measurement. Above all, there is no common underlying theoretical construct to this very heterogeneous research which makes the evaluation and comparison of findings extremely difficult. Furthermore, the varying multi-disciplinary approaches preclude meta-analysis, so that clarification of research in this area must proceed firstly by conceptual unification. We attempt to collate and classify the available research around a multi-level biopsychosocial model, theoretically and semiotically comparable to that used in describing the complex chain of events related to host resistance in infectious disease. Using this underlying construct we attempt to reorganize current knowledge around a unitary concept in order to clarify and indicate potential intervention points for increasing resilience and positive mental health. 2010 Elsevier Ltd. All rights reserved.
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              Working models of attachment shape perceptions of social support: evidence from experimental and observational studies.

              Two studies examined the association between attachment style and perceptions of social support. Study 1 (N = 95 couples) used an experimental paradigm to manipulate social support in the context of a stressful task. Insecure participants (anxious and avoidant) who received low-support messages appraised these messages more negatively, rated a prior behavioral interaction with their partner as having been less supportive, and performed significantly worse at their task compared with secure participants. Study 2 (N = 153 couples) used a similar paradigm except that partners were allowed to send genuine support messages. Insecure participants (especially fearful) perceived their partners' messages as less supportive, even after controlling for independent ratings of the messages and relationship-specific expectations. These studies provide evidence that individuals are predisposed to appraise their support experiences in ways that are consistent with their chronic working models of attachment, especially when the support message is ambiguous. ((c) 2004 APA, all rights reserved)

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                07 August 2020
                07 August 2020
                : 11
                1 Center for Lifestyle and Mental Health, School of Psychology, Shenzhen University , Shenzhen, China
                2 University of Electronic Science and Technology of China , Chengdu, China
                3 Innsbruck Medical University , Innsbruck, Austria
                4 Texas A&M University , College Station, TX, United States
                5 Medical University of Vienna , Vienna, Austria
                6 Massachusetts General Hospital, Harvard Medical School , Boston, MA, United States
                7 Primary Care Department, Azienda ULSS 3 (Unità Locale Socio Sanitaria) "Serenissima", Dolo-Mirano District , Venice, Italy
                8 Anhui Jianzhu University , Hefei, China
                9 Arkansas State University , Jonesboro, AR, United States
                10 Department of Psychiatry, University of Toronto and Centre for Addiction and Mental Health (CAMH) , Toronto, ON, Canada
                11 Alberta Health Services , Calgary, AB, Canada
                12 University of Calgary , Calgary, AB, Canada
                13 Early Psychosis: Intervention and Clinical-detection (EPIC) lab, Department of Psychosis Studies, King’s College London , London, United Kingdom
                14 Department of Brain and Behavioral Sciences, University of Pavia , Pavia, Italy
                15 Neuroscience Center, University of Padua , Padua, Italy
                Author notes

                Edited by: Stefan Borgwardt, University of Basel, Switzerland

                Reviewed by: Ahmed Jerome Romain, University of Montreal Hospital Centre (CRCHUM), Canada; Xiao Zhou, Zhejiang University, China

                *Correspondence: Liye Zou, liyezou123@

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Copyright © 2020 Chi, Becker, Yu, Willeit, Jiao, Huang, Hossain, Grabovac, Yeung, Lin, Veronese, Wang, Zhou, Doig, Liu, Carvalho, Yang, Xiao, Zou, Fusar-Poli and Solmi

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 59, Pages: 9, Words: 5377
                Funded by: Chinese National Funding of Social Sciences 10.13039/501100012456
                Original Research


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