Treating Health Anxiety: A Cognitive-Behavioral Approach

AIMS: Chinese university students are at high risk for depressive symptoms and the ongoing coronavirus disease 2019 (COVID-19) pandemic may have exacerbated the mental health of university students. However, existing studies on depressive symptoms in Chinese university students during the COVID-19 pandemic reported a wide range of prevalence estimates, making mental health planning for this population difficult. The objective of this study was to conduct a systematic review and meta-analysis of surveys that assessed the prevalence of depressive symptoms in Chinese university students amid the COVID-19 pandemic. METHODS: Major Chinese (CNKI, Wanfang, VIP) and English (PubMed, Embase, PsycInfo) databases and preprint platforms were searched to identify cross-sectional studies containing data on the prevalence of depressive symptoms in Chinese university students during the pandemic. Two authors independently retrieved the literature, evaluated the eligibility of potential studies, assessed the risk of bias (RoB) of included studies, and extracted data. RoB was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. RESULTS: In total, 1177 records were retrieved, and 84 studies involving 1 292 811 Chinese university students during the pandemic were included. None of the included studies were rated as completely low RoB. Statistically significant heterogeneity in the prevalence estimates of included studies was detected (I2 = 99.9%, p < 0.001). The pooled prevalence of depressive symptoms was 26.0% (95%CI: 23.3-28.9%), which was significantly higher in female than in male students (30.8% v. 28.6%, p < 0.001), in postgraduates than in undergraduates (29.3% v. 22.9%, p < 0.001), in students living inside than in those living outside the COVID-19 epicentre (27.5% v. 22.3%, P < 0.001), in students from universities at the epicentre than in those from universities outside the epicentre (26.2% v. 23.1%, p < 0.001), in students who had close contact with COVID-19 than in those who did not (46.0% v. 25.0%, p < 0.001), and in students who had acquaintances or relatives infected with COVID-19 (39.7% v. 24.0%, p < 0.001) than in those who did not. Five sources of heterogeneity were identified from the subgroup analysis: survey period, % of males among the survey sample, scale of depressive symptoms, cutoff score of the scale and level of RoB. CONCLUSIONS: Over one-fourth of Chinese university students experienced depressive symptoms during the COVID-19 pandemic. Mental health services for this population should include periodic evaluation of depressive symptoms, expanded social support and psychiatric assessment and treatment when necessary. It is also necessary to design depression prevention programmes that target higher-risk cohorts of university students.

/pdf/prevalence-of-depressive-symptoms-among-chinese-university-2a6d0j3hxu.pdf

Prevalence of depressive symptoms among Chinese university students amid the COVID-19 pandemic: a systematic review and meta-analysis.

The COVID-19 pandemic led to a shutdown of universities in Germany. In a longitudinal design, we compared mental health (depression, anxiety, somatic complaints) of university students in Germany before (June to August 2019) and in the course of the COVID-19 pandemic (June 2020) and determined the impact of pandemic-related stress and loneliness on students' mental health in self-report online surveys. We investigated 443 participants (mean age 22.8 years), among them 77% female, and 10.4% medical students. A small increase of depression mean scores was observed (F(1,420) = 5.21; p = .023), anxiety and somatic complaints have not significantly changed. There was a medium increase in loneliness from pre-pandemic scores to the pandemic situation (F(1,423) = 30.56; p < .001). Analyzed with regression analyses, current loneliness and pre-pandemic distress represented the strongest associations with mental health during the pandemic. Additionally, health-related concerns during the pandemic were associated with symptoms of depression [b = 0.21; 95%CI(0.08; 0.34); t = 3.12; p = .002], anxiety [b = 0.07; 95%CI(0.01; 0.12); t = 2.50; p = .013], somatic complaints [b = 0.33; 95%CI(0.18; 0.47); t = 4.49; p < .001], and loneliness [b = 0.10; 95%CI(0.03; 0.17); t = 2.74; p = .006]. Social stress due to the pandemic situation was associated with loneliness [b = 0.38; 95%CI(0.32; 0.45); t = 11.75; p < .001]. The results imply that university students represent a risk group for psychosocial long-term ramifications of the pandemic.

/pdf/the-impact-of-lockdown-stress-and-loneliness-during-the-43zgill77l.pdf

The impact of lockdown stress and loneliness during the COVID-19 pandemic on mental health among university students in Germany.

Background: The 2019 coronavirus disease (COVID-19) pandemic is a public health emergency of international concern. This study aimed to assess the psychological outcomes and their influencing factors among medical and non-medical University students during the COVID-19 pandemic in China. Methods: A cross-sectional online survey using structured questionnaires was conducted from February 20 to March 20, 2020. Psychological outcomes were assessed according to the Depression, Anxiety, and Stress Scale (DASS-21). Influencing factors were assessed by COVID-19 knowledge, mindful coping scale, and sense of control scale. Results: Our sample is comprised of 563 University students (male = 172, mean age = 21.52). Among them, 382 are medical students. Among the participants, 12.26, 18.47, and 8.53% have moderate to severe levels of depression, anxiety, and stress symptoms, respectively. Compared with the non-medical students, the medical students had a higher knowledge level of COVID-19, a higher sense of awareness, and fewer mental health symptoms. After controlling the covariance, perceived constraints of sense of control were negatively associated with depression, anxiety, and stress among both medical and non-medical students. Prevention of negative emotions by mindful coping was negatively associated with depression and anxiety among non-medical students. Knowledge of COVID-19 is not associated with mental distress among medical and non-medical students. Conclusions: During the COVID-19 pandemic in China, the mental health of University students was affected. Our findings suggested that a sense of control is a protective factor for both medical and non-medical students, while mindful coping is a protective factor for only non-medical students.

/pdf/factors-influencing-mental-health-among-chinese-medical-and-2ewc6ngm12.pdf

Factors Influencing Mental Health Among Chinese Medical and Non-medical Students in the Early Stage of the COVID-19 Pandemic.

The COVID-19 pandemic had led universities to introduce lockdowns, which has led to significant shifts in students' lives. Classes were moved online, students had to leave dorms and move; they had to forgo regular meetings with their peers. Subsequently, a vital demand for examining students' mental health emerged. The data were collected at a time when universities in Poland were under lockdowns. Participants represented students of many different fields of study. The General Health Questionnaire (GHQ-28) was used. Student's subjective evaluation of online learning and their adaptation to academic life shifts were reviewed. A total of 1123 participants took part in this study. Relationship analysis included tests, such as U Mann-Whitney, appropriate for specific variables. The impact of variables connected with the pandemic on the GHQ scores was tested using multivariate regression analysis. The results were considered significant at a p-value set at 0.05. Overall, 76.96% of the participants manifested psychopathological symptoms measured by the GHQ. Four demographical variables were possibly associated with the GHQ scores: female sex, living in a big city, necessity to move back home, and being in a relationship. Negative correlations between subjective evaluation of variables concerning e-learning, such as its efficiency or quality, and the GHQ scores were found. Some variables were found to be potential protective factors, whereas others could have contributed to worsened mental health. The study provides data on students' worsened mental health due to the COVID-19 pandemic and the shifts in academic life it caused. Therefore, recommendations for early psychosocial interventions among students are strongly advised.

https://www.mdpi.com/1660-4601/18/6/2884/pdf

Class of 2020 in Poland: Students' Mental Health during the COVID-19 Outbreak in an Academic Setting.

To investigate the immediate psychological effects of Coronavirus Disease 2019 (COVID-19) on medical and non-medical students. An online survey of 805 medical students and 1900 non-medical students was conducted from Feb 4, 2020 to Feb 7, 2020, in China. The questionnaire measured the subjective estimated severity of COVID-19, the impact of the outbreak, and the levels of anxiety and depression of both medical and non-medical students. Medical students estimated COVID-19 to be more serious and disastrous than non-medical students, while they scored lower than non-medical students on the Impact of Event Scale-Revised (IES-R), and less severe anxiety and depression than non-medical students. The students experienced greater impact from the outbreak and a higher rate of anxiety and depression with increased time focusing on the outbreak. The difference in psychological effects between medical and non-medical students was further enlarged when focusing time was prolonged. The immediate psychological effects of COVID-19 on medical and non-medical students exhibit different characteristics. The outcome of this study provides implication that providing accurate and transparent information about the epidemic and appropriate COVID-19-based knowledge in accessible ways will contribute to the public's mental health during the outbreak.

/pdf/the-immediate-psychological-effects-of-coronavirus-disease-31952srjnu.pdf

The immediate psychological effects of Coronavirus Disease 2019 on medical and non-medical students in China.

OBJECTIVES: To evaluate the emotion, coping strategy, dealing methods and their correlation in the COVID-19 outbreak among nursing and non-nursing students. DESIGN AND SETTING: A cross-sectional online survey. PARTICIPANTS: Full-time nursing and non-nursing undergraduate students. MAIN OUTCOME MEASURE: The Generalized Anxiety Disorder 7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to determine the emotional status in the COVID-19 pandemic among nursing and non-nursing students. Emotion Regulation Questionnaire (ERQ) was used to measure the emotion regulation strategies and the Simplified Coping Style Questionnaire (SCSQ) was used to evaluate the coping methods among nursing and non-nursing students. RESULTS: In total, 746 students including 366 nursing students and 380 non-nursing students participated in the survey. Compared with the non-nursing students, a significant decrease was noticed in GAD-7 score (p<0.01) and PHQ-9 (p<0.01) in the nursing students. The cognition re-evaluation score in the nursing students was significantly lower than that of the non-nursing students (p<0.05). In the nursing students, the score of anxiety was positively correlated with ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01), while the score of depression was also positively correlated with ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01). There was a negative correlation between SCSQ and the scores of anxiety (p<0.05) and depression (p<0.05). In the non-nursing students, the anxiety score was positively correlated with the SCSQ negative coping (p<0.01), while the depression score was positively correlated with the ERQ expression inhibition (p<0.01) and SCSQ negative coping (p<0.01). CONCLUSIONS: COVID-19 affected the emotional status of nursing and non-nursing students. The emotional status was correlated with the emotional regulation and coping methods. Staff involved in the nursing professionals should pay attention to the psychological status of the nursing and non-nursing students, and give moderate psychological interference in the presence of COVID-19.

https://bmjopen.bmj.com/content/bmjopen/11/8/e054007.full.pdf

Lin Xie

Papers

The immediate psychological effects of Coronavirus Disease 2019 on medical and non-medical students in China.

Emotional states and coping methods in nursing and non-nursing students responding to COVID-19: a cross-sectional study in China.

The relationship between death attitude and professional identity in nursing students from mainland China.