Prevalence And Risk Factors Of Depression In College Students in Northeast China During the COVID-19 Pandemic: A Cross-sectional Study

doi:10.21203/rs.3.rs-4955067/v1

Download PDF

Research Article

Prevalence And Risk Factors Of Depression In College Students in Northeast China During the COVID-19 Pandemic: A Cross-sectional Study

https://doi.org/10.21203/rs.3.rs-4955067/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

The Coronavirus disease 2019 pandemic spread rapidly worldwide, posing a serious health challenge to the global public. However, few studies exist on the association between health risk behaviors and depression among Chinese college students during the stage. Therefore, this study aimed to explore associated factors including health risk behaviors and life satisfaction among Chinese college students with depression.

Methods

A cross-sectional study was conducted in northeast China from April to June 2020 on purposively sampled from two colleges. Data were collected through the Adolescent Students' Life Satisfaction Scale, Health Risk Behavior Scale, Self-rating Anxiety Scale, and Self-rating Depression Scale. Binary logistic regression was conducted to analyze the risk factors of depression.

Results

The prevalence of depressive state of college students was 32.1%. Students with health-compromising behavior (OR = 1.128, p < 0.001) were positively correlated with depression. Furthermore, satisfaction with friendships (OR = 0.941, p < 0.001), freedom (OR = 0.955, p = 0.004), school (OR = 0.966, p = 0.010), and the environment (OR = 0.933, p < 0.001) were protective factors for students’ depression.

Conclusions

To reduce this depression, schools should increase publicity and education to promote a regular diet among college students, channel adolescents' destructive emotions to prevent them from self-injury and self-harm, enrich their after-school life to strengthen their interpersonal communication, and enhance friendship- building among them.

Depression

College Students

Life Satisfaction

Risky Behavior

Coronavirus disease 2019 (COVID-19) spread rapidly worldwide, posing a serious health challenge to the global public[1, 2]. Consequently, the public has experienced increased physical health problems and mental disorders such as anxiety, depression, and suicide[3, 4]. The impact of the pandemic serves as a greater challenge for adolescents because of their lack of mental capacity and coping skills compared to adults[5, 6]. Adolescents of varying backgrounds experienced higher rates of anxiety, depression, behavioral problems, and suicide during the pandemic. Globally, 10–20% of adolescents suffer from varying degrees of mental health [6, 7].

College marks an important stage for adolescents. Moreover, college students’ mental health has become an increasing concern, including issues related to panic, anxiety, and depression [8]. In general, incidences of depression among university students reached 20–50% during the COVID-19 pandemic[1, 9]. According to a large-scale survey of college students in China (N = 746,217), 21.1% of participants demonstrated symptoms of depression during the pandemic [10]. Many factors contributed to the high incidence of depression among college students during the COVID-19 pandemic, such as a constant fear of infection, social isolation, unhealthy lifestyles, and exposure to media information overload.

Notably, there was an upward trend in health risk behaviors among college students during the COVID-19 outbreak [11]. For example, they were restricted to online classes at home, which increased their health risk behaviors such as being sedentary and overeating. A lack of physical exercise and overeating is highly correlated with anxiety and depression symptoms and lower life satisfaction. In contrast, a healthy lifestyle that includes regular physical activity, a daily routine, good diet, and sufficient sleep help to decrease symptoms of depression and anxiety and improve life satisfaction.

Moreover, due to the lack of in-person support from teachers and interactive learning, online courses from home are likely to increase academic load and frustration, which may increase mental distress and decrease life satisfaction especially in terms of satisfaction with academics, school, and friendships [12]. College students with depression are more likely to cope with stress through negative coping strategies such as addiction behaviors and self-harm. Smartphone and Internet addiction are common among college students who resorted to connecting and socializing in this way because of orders to stay at home and school closures [13]. In addition, college students had a higher frequency of alcohol or cannabis use during the COVID-19 pandemic. Other coping strategies used by college students to deal with psychological problems during the COVID-19 pandemic included non-suicidal self-injury and suicide [14]. These negative coping skills increase the risk of depression among adolescents.

In China, the incidence of depression among college students totaled 20–50% during the COVID-19 pandemic[1, 9]. Unfortunately, few studies focus on the association between health risk behaviors and depression among Chinese college students. Furthermore, some studies indicate differences in health risk behaviors between Eastern and Western college students, including in weight perception, addiction behaviors, and the handling of stressful events [15]. Therefore, relevant studies in the West cannot be fully generalized to the situation in China. Thus, we studied the impacts of health risk behaviors on the health outcomes of Chinese college students. This study aimed to address associated factors including health risk behaviors and life satisfaction among Chinese college students with depression.

Participants and procedures

A questionnaire survey was conducted from April to June 2020 among the first and second-year students of two randomly selected majors from two universities in Harbin, Heilongjiang Province in China. Before that, the investigators were trained by professionals to master the questionnaire method and its related notes (completeness of responses, information confidentiality, etc.). These aspects were explained to the students when they filled out the questionnaire. The investigators distributed the questionnaire to student administrators after communicating with each school's student administration. The questionnaires were distributed to every class and retrieved immediately after students filled them out. In total, 2440 paper questionnaires were distributed, of which 2419 were retrieved. Among these, 2150 were valid after removing those with obvious errors, incorrect answers to lie detector questions, and incomplete answers, giving an effective response rate of 88.11%. All respondents signed an informed consent form.

The inclusion criteria were as follows. Students had to (1) be aged 18–24 years, (2) be able to understand and complete the scale, and (3) voluntarily participate in the study. The exclusion criteria were as follows. Students who (1) came from a single-parent family or were not living with at least one guardian at and before 10 years of age, (2)History of psychotropic drug use or mental illness, and (3) did not have the ability to understand and fill in the questionnaire.

Questionnaire

A self-designed demography questionnaire, the Life Satisfaction Scales Applicable to Chinese Adolescent Students, Adolescent Health Related Risky Behavior Inventory, Self-rating Anxiety Scale, and Self-rating Depression Scale were adopted in the study. Before the official survey, 100 college students were randomly selected from a university for the pre-survey. Based on the pre-survey results and expert opinions, the scale items were modified appropriately and the final questionnaire developed.

Demographic characteristics

A self-designed demography questionnaire was used to collect data. Demographic information included 11 items pertaining to gender, age, grade, place of residence, being an only child or not, monthly family income, parents' educational background, parents' employment, and being physically punished by parents in childhood.

Life Satisfaction Scales Applicable to Chinese Adolescent Students

The Life Satisfaction Scales Applicable to Chinese Adolescent Students (CASLSS), developed by Zhang et al. [16], is based on the Adolescent Multidimensional Life Satisfaction Scale by Huebener [17]. CASLSS includes six dimensions: friendship, family, study, freedom, school, and environment. The scale includes 36 items scored on a seven-point Likert scale ranging from “1 = Completely inconsistent” to “7 = Completely consistent”. The higher the score, the higher the satisfaction. In this study, the Cronbach’s coefficients of each dimension were 0.71, 085, 0.79, 0.87, and 0.71, respectively, and the Cronbach’s coefficient of the entire scale was 0.91.

Adolescent Health Related Risky Behavior Inventory

The Adolescent Health Related Risky Behavior Inventory (AHRBI) by Wang Mengcheng [18], a Chinese scholar, and others includes six dimensions: health compromise, violent aggression, suicide and self-harm, smoking and drinking, discipline violation, and unprotected sex. It includes 38 items scored on a five-point Likert scale (0 = never, 1 = almost never (once a month), 2 = sometimes (2–4 times a month), 3 = almost often (2–3 times a week), 4 = often (more than 4 times a week)). The detection rate for each dimension was calculated based on at least one of the items included in the dimension ≥ 2 points (2–4 times a month). Cronbach’s coefficient for all scales was 0.90, and that of each scale was mostly above 0.75.

Self-rating Anxiety Scale

The Self-rating Anxiety Scale (SAS) by Zung [19]employs a four-point Likert scale, i.e., the scores of 20 items added together are the total gross score, and the integer from the total gross score times 1.25 is the standard score. A standard score of < 50 indicates no anxiety, 50–59 indicates mild anxiety, 60–69 indicates moderate anxiety, and ≥ 70 indicates severe anxiety. Cronbach’s coefficient was 0.697.

Self-rating Depression Scale

The Self-rating Depression Scale (SDS), also by Zung [20], comprises 20 items. Depression severity is the total gross score divided by 80 points (highest total score), where < 0.50 indicates no depression, 0.50–0.59 slight to mild depression, 0.60–0.69 moderate to severe depression, and > 0.70 severe depression. Cronbach’s coefficient was 0.86.

Data analysis

IBM SPSS 26.0 was used for the statistical analysis, with the cut-off values for depression severity set at 0.50, ≥ 0.50, and < 0.50, respectively. A descriptive statistical analysis was performed to analyze the respondents’ level of depression and the mean and standard deviation of each influencing factor. A Chi-square test was conducted to compare the differences in demographic information and scores of each dimension of the scale between the two groups—those with depression and those without. We compared the covariates of the demographic information variables (place of residence, being anxious or not, family income, father’s educational level, mother’s educational level, and degree of physical punishment in childhood) and scores of each dimension of the CASLSS and AHRBI with the dependent variable of the depressive state (1 = not having reached a depressive state, 2 = having reached a depressive state). A multivariate binary logistic regression analysis was also conducted of the dependent variable of being anxious or not and the scores for health-compromising behavior, suicide and self-harm, friendship satisfaction, freedom satisfaction, school satisfaction, and environment satisfaction, alongside a two-sided test with 95% confidence interval to explore the risk factors affecting college students’ depression status. Differences of P < 0.05 were considered statistically significant.

Demographic characteristics of the respondents

The college students participating in the survey were mainly male (54.8%), aged 19 years (44.0%), freshmen (59%), urban (63.7%), only children (64.1%), and from families earning 4001–8000 RMB family income per month (39.7%). Table 1 provides more details.

Table 1

demographic characteristics of participants (N = 2150).
Variables	N	%
Gender
Male	1 179	54.8
Female	971	45.2
Age group
16–18 years old	677	31.5
19 years old	946	44.0
20–26 years old	527	24.5
Grade
Freshman	1 268	59.0
Sophomore	882	41.0
Place of family residence
Country	781	36.3
Urban	1 369	63.7
Only child or not
only children	1 379	64.1
Non- only children	771	35.9
Family income per month
<4 000 yuan	607	28.2
4 001–8 000 yuan	853	39.7
>8 001yuan	690	32.1
Father’s educational level
Mainly junior high school/ primary school or less	741	34.5
High school or technical secondary school	689	32.0
College or above	720	33.5
Father’s occupation
Individual, business and service staff	600	27.9
Farmer	368	17.1
Professionals	225	10.5
Personnel of government organs and public institutions	454	21.1
Staff of the enterprise	213	9.9
Other	290	13.5
Mother’s educational level
Mainly junior high school, primary school or less	886	41.2
High school or technical secondary school	686	31.9
College or above	578	26.9
Mother’s occupation
Individual, business and service staff	604	28.0
Farmer	380	17.7
Professionals	139	6.5
Personnel of government organs and public institutions	425	19.8
Staff of the enterprise	182	8.5
Other	420	19.5
Physically punished in childhood
No	895	41.6
Yes	1255	58.4

Differences in depression scores of college students for diverse variables

The results showed that the prevalence of depressive state of college students is 32.1% (692/2150). Compared with the non-depression group, the depressive state of the depression group demonstrated significant differences in family residence (= 4.309, p = 0.039), monthly family income (= 16.437, p < 0.001), father’s educational level (= 7.907, p = 0.019), mother’s educational level (= 6.217, p = 0.045), and physical punishment in childhood (= 13.383, p < 0.001). Further details are provided in Table 2.

Table 2

Differences in depression scores of college students for diverse variables.
Variables	with depression	without depression	F/	P
Age	18.955 ± 0.897	18.951 ± 0.874	0.009	0.924
Gender (female)	297(42.9%)	674(46.2%)	2.074	0.151
Place of family residence (country)	273(39.5%)	508(34.8%)	4.309	0.039
only children	441(63.7%)	938(64.3%)	0.075	0.810
Family income per month			16.437	< 0.001
< 4000(yuan)	226(32.7%)	381(26.1%)
4000–8000(yuan)	281(40.6%)	572(39.2%)
> 8000(yuan)	185(26.7%)	505(34.6%)
Father’s occupation			7.907	0.019
Mainly junior high school, primary school or less	254(36.7%)	487(33.4%)
High school or technical secondary school	235(34.0%)	454(31.1%)
College or above	203(29.3%)	517(35.5%)
Mother’s educational level			6.217	0.045
Mainly junior high school, primary school or less	282(40.8%)	604(41.4%)
High school or technical secondary school	243(35.1%)	443(30.4%)
College or above	167(24.1%)	411(28.2%)
Physically punished in childhood			13.383	< 0.001
No	249(36.0%)	646(44.3%)
Yes	443(64.0%)	812(55.7%)
Total score of Health Compromise	3.684 ± 3.235	1.877 ± 1.971	255.256	< 0.001
Total score of violent attacks	4.390 ± 5.796	1.881 ± 2.044	216.628	< 0.001
Total score of suicide and self-mutilation	1.734 ± 3.010	0.207 ± 0.743	332.783	< 0.001
Total score of smoking and drinking	2.270 ± 4.151	0.644 ± 1.470	177.136	< 0.001
Total score of breaking the rules	3.046 ± 4.121	1.381 ± 1.476	187.389	< 0.001
Total score of unprotected	0.993 ± 2.965	0.049 ± 0.598	136.020	< 0.001
Friendship satisfaction	32.921 ± 7.746	39.602 ± 5.492	526.594	< 0.001
Family satisfaction	34.538 ± 9.206	41.797 ± 6.628	433.439	< 0.001
School satisfaction	26.383 ± 6.518	32.746 ± 6.300	468.134	< 0.001
Academic satisfaction	23.393 ± 7.634	28.453 ± 6.893	235.660	< 0.001
Freedom satisfaction	23.145 ± 5.995	28.474 ± 4.720	499.763	< 0.001
Environmental satisfaction	22.439 ± 4.840	27.466 ± 4.900	497.871	< 0.001

Results of Binary logic regression analysis

The results in Table 3 show that health-compromising behavior, suicide and self-harm, friendship satisfaction, freedom satisfaction, school satisfaction, and environment satisfaction are risk factors for college students’ depressive state. Furthermore, college students with health-compromising behavior (OR = 1.128, p < 0.001) had a clear positive correlation with a depressive state, that is, college students with health compromising behavior were at a higher risk of depression. Furthermore, college students satisfied with school had lower depression (OR = 0.966, p = 0.010) than those dissatisfied with it. Finally, students satisfied with the environment had lower depression (OR = 0.933, p < 0.001) than dissatisfied with it (see Table 3).

Table 3

Binary logistic regression analysis.
Variables	B	Wsld X²	OR	95% CI	P
Total score of Health Compromise	0.121	20.826	1.128	1.017–1.188	<0.001
Total score of suicide and self-mutilation	0.385	42.123	1.470	1.309–1.651	<0.001
Friendship satisfaction	-0.060	17.091	0.941	0.915–0.969	<0.001
Freedom satisfaction	-0.046	8.516	0.955	0.926–0.985	0.004
School satisfaction	-0.034	6.560	0.966	0.941–0.992	0.010
Environmental satisfaction	-0.069	16.885	0.933	0.903–0.965	<0.001

This study was a large sample epidemiological survey of university students in northeastern China. The study investigated the main risk factors for a depressive state among college students in northeastern China. Our findings revealed significant differences between college students with and without depression in terms of place of residence, family income, parents’ education, physical punishment during childhood, adolescent health-related risk behaviors, and adolescent life satisfaction. Further exploration revealed that health-compromising behavior, suicidal and self-injury behaviors, school satisfaction, friendship satisfaction, freedom satisfaction, and environmental satisfaction were independent risk factors for a depressed state among college students.

Our study found that the higher the health-compromising behavior score of college students, the more severe was their depression. Health-related risk behaviors included aggressive violence, disciplinary disruption, suicidal self-injury, health-compromising behaviors, unprotected sexual behaviors, smoking, and drinking[21]. In this study, we found that college students with depression had higher total health-compromising behavior scores, higher total scores for violent aggression, more suicidal self-injurious behaviors, were more likely to break discipline, and smoked and drank alcohol more. Further study found that health-compromising behavior is a risk factor for a depressed state among college students. An unhealthy diet and lack of physical activity also negatively affect health and are therefore considered health risk behaviors [22]. Health promotion and incorporating health-protective behaviors into people's lifestyles have gone a long way in recent years to improve individuals' overall health and well-being. Studies have found that college students are at increased risk of developing unhealthy diets and lifestyles [23]. Several studies supported our results that a lack of physical activity increases health risk [24]. Prolonged sitting can increase the risk of developing chronic conditions like obesity, metabolic syndrome, and depression [25]. In addition, as shown in the literature, skipping breakfast is common among college students. Mansouri et al. [26] reported that regular breakfast consumption was negatively associated with overweight and obesity among college students. Poor eating behaviors among college students may increase the risk of developing mood disorders, and understanding their overall eating behaviors may be necessary to reduce this risk. A logical explanation may be that when college students with depression fail to follow general health advice pertaining to moderate eating or eating breakfast on time, they may not develop good eating habits, but instead overeat, diet excessively, or skip breakfast. A comparative study showed that students who perceived their health as good, very good, or excellent had healthier behaviors, and that university health and wellness initiatives should focus on the mental and physical health of college students to help them develop positive behaviors that affect overall health-related quality of life. Therefore, health-related risk behaviors should be a point of focus, as these will likely persist into adult life with various negative consequences.

Our findings showed that suicidal and self-injury behaviors were positively associated with a depressed state among college students. Previous studies have related depression with the severity of suicidal ideation in a sample of college students at high risk of suicidal behavior due to past suicide attempts[27]. This finding is consistent with the results of our study. Suicidal behavior among college students is associated with various factors such as psychopathology, stressful life events, personality traits, the rapid growth of higher education, and high expectations students must meet, all of which increase their psychological stress. Anxiety and despair due to the aforementioned factors can moderate the relationship between stress and depressive symptoms and promote the onset of depression[28]. The occurrence of suicidal behavior and depression may also be related to school belonging. A recent study showed that the interaction between loneliness and school belonging increased the risk of suicide and the resulting risk such as suicidal behavior and depression, which could serve as predictors[29]. These findings suggest that suicidal behavior and the occurrence of depression are closely related. Non-suicidal self-injury (NSSI) behavior among college students is a current social concern. One study showed that NSSI behavior has specific emotional characteristics such as eating disorders, depression, anxiety, and stress. Moreover, college students with prior experience of NSSI have fewer adaptive coping strategies when they encounter problems that may lead to emotional difficulties such as the emergence of a depressed mood, which supports our findings. The association between NSSI and depression may be closely related to neuroticism. Studies have shown that neuroticism significantly negatively predicts mood regulation, and positively predicts depression and NSSI [30]. Highly neurotic people are prone to negative emotions such as anger, shame, and guilt. When unable to deal with these emotions effectively, they seek mental stimulation by punishing themselves or through NSSI. Other negative emotions, especially depression, are also generated. NSSI behaviors and a depressed state in patients with high neuroticism are closely related [31]. Our findings suggest that we should be highly concerned about the possibility of depression among college students with a history of suicidal or self-injurious behavior.

Life satisfaction is a cognitive component of an individual's subjective well-being, and is closely related to the psychological health of college students [32]. Survey results regarding college students’ life satisfaction can significantly predict their social, behavioral, and psychological problems (depression and anxiety). The results of this study showed that the life satisfaction of college students with depression was significantly different from that of those who were not depressed in all six dimensions (friendship, family, school, academics, freedom, and environment) (Table 1, all p < 0.001) [33]. Consistent with the results of this study, a Chinese questionnaire survey of 439 college students aged 17–24 years found that life satisfaction was positively associated with self-esteem and social support and negatively associated with variables such as depression and suicidal ideation [34]. Similarly, a US study of 508 full-time undergraduate students aged 18–24 years found that life satisfaction was a significant independent predictor of depression. In addition, a study investigating 1,224 university students in Brazil during the COVID-19 pandemic found that depression and anxiety were negatively associated with life satisfaction, mental health, and adaptive coping styles, and positively associated with poor coping styles. Many results support a negative correlation between life satisfaction and depression [35, 36]. To explain this phenomenon, some scholars have proposed that the generation of depression and anxiety may be related to people's inability to satisfy their needs in valuable areas of their lives. As low satisfaction does not bring people happy emotions, this leads to depression [37]. In conclusion, effectively improving college students' life satisfaction is beneficial to their mental health and may help reduce their risk of depression. It is noteworthy that although an increasing number of studies link mental health and life satisfaction, few have refined the different dimensions of life satisfaction among college students. A logistic regression in this study revealed that school satisfaction, friendship satisfaction, freedom satisfaction, and environmental satisfaction were independent risk factors for a depressed state among college students. Note that this study did not find that family and academic satisfaction significantly predicted a depressed state among college students. This differs from the results of previous studies [38], which may be related to cultural differences. China tends to have a strict entrance scoreline for college students, but it is relatively easy to study after enrollment. However, in some Western countries, the opposite is true [39]. In addition, most of the residence patterns of Chinese university students are residential, and few students live with their families. When faced with more challenges and tasks, the emotional impact of family on them may be diluted. In conclusion, it is recommended that university health professionals have a targeted focus on college students’ life satisfaction and implement strategies and programs to reduce their depression.

Limitations of this study

This study has some limitations. First, it is cross-sectional and cannot infer an actual causal relationship. In the future, we could conduct a longitudinal follow-up study to clarify the results. Second, this study has many retrospective questions, and there may be recall bias when participants answer these types of questions, which may affect the final results. Third, some confounding factors were not included in this study, such as smoking frequency, alcohol use, and other factors that play an important role in depression. Fourth, we did not collect information on our participants’ health conditions such as the body mass index or any diseases. Thus, the findings of this study cannot be extended to all Chinese college students. Finally, this study did not include a healthy control group. Future studies including those with a longitudinal cohort should use a broader range of samples and collect more information on the aspects not covered here.

During the pandemic, college students were easily affected by many factors. To reduce depression among them, schools can increase publicity and education to promote the importance of a regular diet, promptly channel adolescents' destructive emotions to prevent them from self-injury and self-harm, enrich their after-school life to strengthen their interpersonal communication, and enhance friendship-building among them to reduce their health-compromising behaviors. In general, reducing the health-compromising behaviors of adolescents and enhancing their life satisfaction are highly significant in reducing the occurrence of adolescent depression.

COVID-19

Coronavirus disease 2019

CASLSS

Life Satisfaction Scales Applicable to Chinese Adolescent Students

AHRBI

Adolescent Health Related Risky Behavior Inventory

SAS

Self-rating Anxiety Scale

SDS

Self-rating Depression Scale

Ethics Declaration

In accordance with the Declaration of Helsinki, the study has been approved by Ethics Committee of the Harbin Medical University (approval number HMUIRB20200008). The sensitive information was surveyed by non-real name, and the informed consent was obtained before the investigation.

Competing interests

No conflict of interest was disclosed for each author.

Consent for publication

Not applicable

Funding

This work was supported by the First Affiliated Hospital of Harbin Medical University [2024B01]; the basic scientific research business expenses of Heilongjiang Provincial Key Research and Development Program Project [2023ZX06C05]; The First Affiliated Hospital of Harbin Medical University Fund for Distinguished Young Scholars [2024JQ05];and The First Affiliated Hospital of Harbin Medical University Fund for Outstanding Youth [2024YQ08];and Natural Science Foundation of Heilongjiang Province [LH2022H040)].

Author Contribution

Yanze Cui, Chuanyi Kang and Na Zhao were responsible for study design, statistical analysis, manuscript preparation, Liying Yang, Wanqiu Yang, Jiazhou Liu, and Xiaohong Wang were responsible for the data curation. Jiacheng Liu, Dan Leng, and Borui Yang were involved in evolving the ideas and edit the manuscript. All authors have contributed to and have approved the final manuscript. All authors reviewed the manuscript.

Acknowledgement

We thank all participants and staffs at the study sites for their cooperation. We wish to thank the reviewers for their insightful comments and suggestions.

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–3.
Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264–6.
Xiang Y-T, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228–9.
Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):E14.
de Figueiredo CS, Sandre PC, Lima Portugal LC, Mazala-de-Oliveira T, Chagas LS, Raony I, et al. COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors. Prog Neuro-psychopharmacol Biol Psychiatry. 2021;106:110171.
Meade J. Mental Health Effects of the COVID-19 Pandemic on Children and Adolescents A Review of the Current Research. Pediatr Clin North Am. 2021;68(5):945–59.
Bruining H, Bartels M, Polderman TJC, Popma A. COVID-19 and child and adolescent psychiatry: an unexpected blessing for part of our population? Eur Child Adolesc Psychiatry. 2021;30(7):1139–40.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatry. 2020;33(2):e100213.
Zhao B, Kong F, Aung MN, Yuasa M, Nam EW. Novel Coronavirus (COVID-19) Knowledge, Precaution Practice, and Associated Depression Symptoms among University Students in Korea, China, and Japan. Int J Environ Res Public Health. 2020;17(18):6671.
Ma Z, Zhao J, Li Y, Chen D, Wang T, Zhang Z, et al. Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiol Psychiatric Sci. 2020;29:e181.
Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;59:1218–39.
Xiao P, Chen L, Dong X, Zhao Z, Yu J, Wang D, et al. Anxiety, Depression, and Satisfaction With Life Among College Students in China: Nine Months After Initiation of the Outbreak of COVID-19. Front Psychiatry. 2022;12:777190.
Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on Mental Health in Adolescents: A Systematic Review. Int J Environ Res Public Health. 2021;18(5):2470.
Zhang C, Ye M, Fu Y, Yang M, Luo F, Yuan J, et al. The Psychological Impact of the COVID-19 Pandemic on Teenagers in China. J Adolesc Health. 2020;67(6):747–55.
Ye Y-l, Wang P-g, Qu G-c, Yuan S, Phongsavan P, He Q-q. Associations between multiple health risk behaviors and mental health among Chinese college students. Psychol Health Med. 2016;21(3):377–85.
Zhang X, He L, Zheng X. Adolescent students' life satisfaction: its construct and scale development. Psychol Sci. 2004:1257–60.
Huebner ES. Preliminary development and validation of a multidimensional life satisfaction scale for children. Psychol Assess. 1994;6:149–58.
Wang M, Yi J, Cai L, Hu M, Wang Y, Zhu X, et al. Reliability and validity of the Adolescent Health Related Risky Behavior Inventory. Chin Mental Health J. 2012;26:287–92.
Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12:371–9.
Zung WW, A SELF-RATING DEPRESSION, SCALE. Arch Gen Psychiatry. 1965;12:63–70.
Wang M, Yi J, Cai L, Hu M, Zhu X, Yao S, et al. Development and psychometric properties of the health-risk behavior inventory for Chinese adolescents. BMC Med Res Methodol. 2012;12:94.
Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults With Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement. Jama-Journal Am Med Association. 2020;324:2069–75.
Alkhalidy H, Orabi A, Alzboun T, Alnaser K, Al-Shami I, Al-Bayyari N. Health-Risk Behaviors and Dietary Patterns Among Jordanian College Students: A Pilot Study. Front Nutr. 2021;8:632035.
Vainshelboim B, Brennan GM, LoRusso S, Fitzgerald P, Wisniewski KS. Sedentary behavior and physiological health determinants in male and female college students. Physiol Behav. 2019;204:277–82.
Meyer MRU, Wu C, Walsh SM. Theoretical Antecedents of Standing at Work: An Experience Sampling Approach Using the Theory of Planned Behavior. AIMS public health. 2016;3:682–701.
Mansouri M, Hasani-Ranjbar S, Yaghubi H, Rahmani J, Tabrizi YM, Keshtkar A, et al. Breakfast consumption pattern and its association with overweight and obesity among university students: a population-based study. Eat Weight Disorders-Studies Anorexia Bulimia Obes. 2020;25:379–87.
Chesin MS, Jeglic EL. Factors Associated with Recurrent Suicidal Ideation among Racially and Ethnically Diverse College Students with a History of Suicide Attempt: The Role of Mindfulness. Archives Suicide Res. 2016;20:29–44.
Zhang C, Shi L, Tian T, Zhou Z, Peng X, Shen Y, et al. Associations Between Academic Stress and Depressive Symptoms Mediated by Anxiety Symptoms and Hopelessness Among Chinese College Students. Psychol Res Behav Manage. 2022;15:547–56.
Zhou C, Gao M, Shi X, Zhang Z. Suicidal behavior, depression and loneliness among college students: the role of school belonging. Psychol Health Med. 2022;28(6):1520–6.
Liao C, Gu X, Wang J, Li K, Wang X, Zhao M, et al. The Relation between Neuroticism and Non-Suicidal Self-Injury Behavior among College Students: Multiple Mediating Effects of Emotion Regulation and Depression. Int J Environ Res Public Health. 2022;19(5):2885.
Basgoze Z, Wiglesworth A, Carosella KA, Klimes-Dougan B, Cullen KR, Depression. Non-Suicidal Self-Injury, and Suicidality in Adolescents: Common and Distinct Precursors, Correlates, and Outcomes. J psychiatry brain Sci. 2021;6(5):e210018.
Yuksel A, Bahadir-Yilmaz E. Relationship between depression, anxiety, cognitive distortions, and psychological well-being among nursing students. Perspect Psychiatr Care. 2019;55:690–6.
Mahoney JW, Quested E, Thogersen-Ntoumani C, Ntoumanis N, Gucciardi DF. Validating a measure of life satisfaction in older adolescents and testing invariance across time and gender. Pers Indiv Differ. 2016;99:217–24.
Zhang J, Zhao S, Lester D, Zhou C. Life satisfaction and its correlates among college students in China: a test of social reference theory. Asian J psychiatry. 2014;10:17–20.
Shek DTL, Li X. Perceived School Performance, Life Satisfaction, and Hopelessness: A 4-Year Longitudinal Study of Adolescents in Hong Kong. Soc Indic Res. 2016;126:921–34.
Shi M, Wang X, Bian Y, Wang L. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: a cross-sectional study. BMC Med Educ. 2015;15:16.
Chan SHW, Pan Y, Xu Y, Yeung KC. Life satisfaction of 511 elderly Chinese stroke survivors: moderating roles of social functioning and depression in a quality of life model. Clin Rehabil. 2021;35:302–13.
Lun KWC, Chan CK, Ip PKY, Ma SYK, Tsai WW, Wong CS, et al. Depression and anxiety among university students in Hong Kong. Hong Kong Med J. 2018;24:466–72.
Jiang X, Chen Y, Ao N, Xiao Y, Du F. A Depression-Risk Mental Pattern Identified by Hidden Markov Model in Undergraduates. Int J Environ Res Public Health. 2022;19(21):14411.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
30 Aug, 2024
Editor assigned by journal
29 Aug, 2024
Submission checks completed at journal
29 Aug, 2024
First submitted to journal
22 Aug, 2024

You are reading this latest preprint version

Prevalence And Risk Factors Of Depression In College Students in Northeast China During the COVID-19 Pandemic: A Cross-sectional Study

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Background

Methods

Participants and procedures

Questionnaire

Demographic characteristics

Life Satisfaction Scales Applicable to Chinese Adolescent Students

Adolescent Health Related Risky Behavior Inventory

Self-rating Anxiety Scale

Self-rating Depression Scale

Data analysis

Results

Demographic characteristics of the respondents

Differences in depression scores of college students for diverse variables

Results of Binary logic regression analysis

Discussion

Limitations of this study

Conclusions

Abbreviations

Declarations

Ethics Declaration

Competing interests

Consent for publication

Funding

Author Contribution

Acknowledgement

References

Additional Declarations

Status:

Version 1