Prevalence and Socio-Demographic Correlates of Psychological Health Problems in Chinese Adolescents During the Outbreak of COVID
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European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-020-01541-4 ORIGINAL CONTRIBUTION Prevalence and socio‑demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID‑19 Shuang‑Jiang Zhou1 · Li‑Gang Zhang1 · Lei‑Lei Wang1 · Zhao‑Chang Guo2 · Jing‑Qi Wang3 · Jin‑Cheng Chen4 · Mei Liu5 · Xi Chen6 · Jing‑Xu Chen1 Received: 31 March 2020 / Accepted: 23 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Psychological health problems, especially emotional disorders, are common among adolescents. The epidemiology of emo- tional disorders is greatly infuenced by stressful events. This study sought to assess the prevalence rate and socio-demo- graphic correlates of depressive and anxiety symptoms among Chinese adolescents afected by the outbreak of COVID-19. We conducted a cross-sectional study among Chinese students aged 12–18 years during the COVID-19 epidemic period. An online survey was used to conduct rapid assessment. A total of 8079 participants were involved in the study. An online survey was used to collect demographic data, assess students’ awareness of COVID-19, and assess depressive and anxiety symptoms with the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) questionnaire, respectively. The prevalence of depressive symptoms, anxiety symptoms, and a combination of depressive and anxiety symptoms was 43.7%, 37.4%, and 31.3%, respectively, among Chinese high school students during the COVID-19 outbreak. Multivariable logistic regression analysis revealed that female gender was the higher risk factor for depressive and anxiety symptoms. In terms of grades, senior high school was a risk factor for depressive and anxiety symptoms; the higher the grade, the greater the prevalence of depressive and anxiety symptoms. Our fndings show there is a high prevalence of psychological health problems among adolescents, which are negatively associated with the level of awareness of COVID-19. These fndings sug- gest that the government needs to pay more attention to psychological health among adolescents while combating COVID-19. Keywords Depression · Anxiety · COVID-19 · Prevalence · Adolescents Introduction Shuang-Jiang Zhou and Li-Gang Zhang contributed equally to this work. They should be regarded as joint frst authors. The 2019 novel coronavirus disease (COVID-19) frst broke Electronic supplementary material The online version of this out in Wuhan, Hubei Province, China, on 31 December article (https ://doi.org/10.1007/s0078 7-020-01541 -4) contains 2019, and it was later declared an international public health supplementary material, which is available to authorized users. emergency by the World Health Organization (WHO) [1]. * Jing-Xu Chen The novel coronavirus disease has spread to 201 countries/ [email protected] territories outside of China and infected 634,835 patients globally [2] (81,470 in China [3]) as of March 29, 2020. It 1 Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing 10096, is worrying that so many people and countries have been China afected so quickly. The outbreak of COVID-19 has caused 2 The First High School of Juxian, Rizhao, Shandong, China mental health problems among the public and health care workers in China [4, 5]. For instance, it has caused public 3 Binhai Eco-City School-Tianjin Nankai High School, Tianjin, China panic and mental health stress [4]. The increasing number of confrmed cases and the increasing number of outbreak- 4 The Experimental Middle School of Chengde, Chengde, Hebei, China afected provinces and countries have led to the public’s fears that they may be infected. In particular, adolescents 5 The Hospital of Nankai University, Tianjin, China are a vulnerable group that is presenting with more and more 6 Hebei Tangshan Foreign Language School, Tangshan, Hebei, complex issues [6]. China Vol.:(0123456789)1 3 European Child & Adolescent Psychiatry Mental health is considered to be the most essential Methods condition for a good quality of life. Adolescents with good mental health can bring their happiness and self- Design and subjects confidence into adulthood, thus providing the ability to cope with adversity [7]. Mental health disorders account We conducted this cross-sectional study using an online for 16% of the global burden of disease and injury among survey to assess mental health problems from March 8 to people aged 10–19 years [8]. It is estimated that 10–20% March 15, 2020. Junior and senior high school students in of children and adolescents throughout the world are China aged 12–18 years were invited to participate in the troubled by mental health problems [9]. Globally, depres- online survey through the Wenjuanxing platform (https :// sion is the fourth leading cause of disease and disability www.wjx.cn/app/surve y.aspx). In total, 8140 participants among adolescents aged 15–19 years, and the 15th for took part in the survey. After removing the data of partici- those aged 10–14 years. Meanwhile, anxiety is the ninth pants with incomplete questionnaires, 8079 participants leading cause of disease and disability for adolescents from 21 provinces and autonomous regions were included aged 15–19 years and sixth for those aged 10–14 years in the analysis. These regions can represent the overall [10]. Studies have reported high detection rates of mental conditions of China. There is no signifcant diference in problems in Chinese children and adolescents, ranging the infection rate of COVID-19 in other regions except from 10.7 to 27.6% [11–15]. Various emotional or behav- Hubei. We divided the participants into from Hubei region ioral problems affect at least 30 million Chinese children and from other regions. The province of Hubei has a pop- and adolescents under 17 years of age [16]. Further stud- ulation of 59,270,000 and includes the city of Wuhan; ies showed that the incidence of behavioral and emotional Hubei province incurred the highest rate of infections and problems was 17.6% among Chinese school children and deaths in China. adolescents aged 6–16 [17]. The mental health problems Approval for the study was obtained from the Ethics of adolescents include conduct disorders, emotional dis- Committee of Beijing HuiLongGuan Hospital. All the par- orders, self-harm, eating disorders, and hyperkinetic dis- ticipants provided online informed consent to participate orders [10, 17–19]. Additionally, there is more and more in the study. evidence that the prevalence of adolescent emotional disorders is increasing [20]. For example, the 12-month prevalence of major depressive episodes in adolescents Assessment tools and procedure increased from 8.7% in 2005 to 11.3% in 2014 in the United States [21]. A data collection sheet was designed to collect basic Stressful events are potent adverse environmental fac- socio-demographic information and students’ awareness tors that can predispose individuals to psychiatric disor- of COVID-19 (COVID-19 knowledge, prevention and ders, in particular depression [22–24]. In addition, studies control measures, projections of COVID-19 trend), and have shown that during an epidemic outbreak, the public two specifc mental symptoms, depressive and anxiety experiences negative emotional responses, such as anxi- symptoms, were assessed through the online survey. The ety and depression symptoms [25, 26]. Current studies questions about the awareness of COVID-19 asked partici- have shown that COVID-19 causes moderate-to-severe pants to select responses from a self-made questionnaire. symptoms of anxiety and depression in about one-third of For the frst questions, respondents were asked about their adults for Chinese people [27]. The National Health Com- familiarity with information about prevention and control mission has released guidelines to promote psychologi- of COVID-19, with responses ranging from 1 (“very unfa- cal crisis intervention for patients, people under medical miliar”) to 10 (“very familiar”). In the second question, observation, medical workers, and civilians during the respondents were asked if they had taken all the optional COVID-19 outbreak [28]. However, it is not clear what is prevention and control measures against COVID-19 to the occurrence and distribution of depressive and anxiety avoid infection, and the response range was from 1 (“very symptoms in adolescents. Therefore, it is necessary to consistent”) to 10 (“very inconsistent”). In the third ques- quickly assess depressive and anxiety symptoms related tion, respondents were asked about their attitudes towards to emergencies for civilians, especially adolescents [29]. the projections of COVID-19 trend, ranging from 1 (“very The objective of the current study was to assess the pessimistic”) to 10 (“very optimistic”). prevalence of two specific mental symptoms, anxiety Depressive symptoms were assessed by the Patient and depression, and their socio-demographic correlates Health Questionnaire (PHQ-9) [30–33], which consists among adolescents in the Chinese population during the of nine items. The PHQ-9 is a simple, highly efective COVID-19 outbreak. self-assessment tool for depression. Participants are asked 1 3 European Child & Adolescent Psychiatry to report the presence of nine problems, including depres- without depressive symptoms. The same method was used to sion and interest decline, in the last 2 weeks on a 4-point compare the diference between the groups with and without scale ranging from “nearly every day” (3 points) to “not at anxiety symptoms. Logistic regression was used to analyze all” (0 points) [31, 33]. The scores for symptom severity the predictors of depression and anxiety symptoms. With were 5–9 for mild, 10–14 for moderate, and 15–19 mod- versus without depressive symptoms and with versus with- erately severe, 20–27 for severe. The PHQ-9 has a good out anxiety symptoms represent dichotomous dependent var- internal consistency, with a Cronbach’s alpha coefcient iables. The level of signifcance was set at 0.05 (two-sided). between 0.80 and 0.90 [30–33]. Reliability and validity in the general population, as well as in patients with mental disorders, have been demonstrated [34, 35].