ORIGINAL RESEARCH published: 26 January 2021 doi: 10.3389/fpubh.2020.588578 Depressive Symptoms, Sleep Quality and Diet During the 2019 Novel Coronavirus Epidemic in China: A Survey of Medical Students Jianping Xie 1,2,3†, Xia Li 1†, Haiyun Luo 1†, Liu He 1, Yufan Bai 1, Fuyun Zheng 1, Lanchun Zhang 2, Jiaqing Ma 1, Zhiqiang Niu 1, Yubing Qin 1, Ling Wang 1, Wenjie Ma 1, Haofei Yu 2, Rongping Zhang 2,4* and Ying Guo 1* 1 School of Basic Medical Sciences, Kunming Medical University, Kunming, China, 2 School of Pharmaceutical Science, Department of Zoology & Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, China, 3 Department of Technology, Library, Yunnan Minzu University, Kunming, China, 4 School of Chinese Materia Medica and Yunnan Key Laboratory of Southern Medicinal Resources, Yunnan University of Chinese Medicine, Kunming, Edited by: China Wulf Rössler, Charité—Universitätsmedizin The psychological condition of medical students may be influenced by the 2019 novel Berlin, Germany coronavirus (COVID-19) outbreak. This study investigated the prevalence and influencing Reviewed by: Yaoguang Zhou, factors of depressive symptoms, poor sleep quality and poor diet in students at Kunming Second Military Medical Medical University during the early part of the COVID-19 outbreak. A cross-sectional University, China Cyrus S. H. Ho, study was used from a questionnaire survey in February 2020. Of a total of 1,026 study National University Health participants, the prevalence of depressive symptoms, poor sleep quality, and poor diet System, Singapore was, respectively, 22.4, 33.2, and 17.4%. Male students and students with a low degree *Correspondence: of focus on COVID-19 had a high risk of depressive symptoms. A high percentage of Ying Guo [email protected] females and students in the fifth grade, as well as students with high levels of concern Rongping Zhang about the negative impact of COVID-19 on their education or employment, comprised [email protected] those with poor sleep quality. Students in the fifth grade and students with high levels †These authors have contributed of concern about the negative impact of COVID-19 on their education or employment equally to this work were more likely to report poor diet. This study suggests the importance of monitoring Specialty section: medical students’ depressive state during the COVID-19 outbreak, and universities are This article was submitted to encouraged to institute policies and programs to provide educational counseling and Public Mental Health, a section of the journal psychological support to help students to cope with these problems. Frontiers in Public Health Keywords: academic stress, employment pressure, COVID-19, medical students, depression Received: 29 July 2020 Accepted: 31 December 2020 Published: 26 January 2021 INTRODUCTION Citation: Xie J, Li X, Luo H, He L, Bai Y, According to epidemiological data published in Nature, the prevalence of depression in China Zheng F, Zhang L, Ma J, Niu Z, Qin Y, was reported to be 3.02% (1). The lifetime prevalence of depressive disorders was 6.9%, while Wang L, Ma W, Yu H, Zhang R and the 12-months prevalence of depressive disorders was 3.6% (2). The prevalence of depressive Guo Y (2021) Depressive Symptoms, disorder was 8.8% of the study population among college students in China (3). The prevalence Sleep Quality and Diet During the 2019 Novel Coronavirus Epidemic in of depression among medical students in China has been reported with a mean of 32.74%, China: A Survey of Medical Students. based on a published meta-analysis (4). In America, the prevalence rates of depression in college Front. Public Health 8:588578. students ranged from 7 to 9% (5), while the prevalence of 6.0–66.5% for depression in medical doi: 10.3389/fpubh.2020.588578 students was recorded (6). Additionally, the number of students at universities who suffered Frontiers in Public Health | www.frontiersin.org 1 January 2021 | Volume 8 | Article 588578 Xie et al. A Survey of Medical Students from mental problems was increasing (7). Since December grade students, 225 (21.9%) third grade students, 229 (22.3%) 2019, cases of pneumonia have appeared in Wuhan city, fourth grade students, and 146 (14.2%) fifth grade students. Hubei Province, China (8, 9). This kind of pneumonia is a highly contagious disease caused by the 2019 novel coronavirus Data Collection (COVID-19), which is characterized by a rapid transmission. This study was conducted during the early outbreak of Among those who developed symptoms, about 15% became COVID-19 in February 2020, and data were collected from seriously ill and 5% became critically ill. Complications leading to February 18 to February 22 through online questionnaires. death may include respiratory failure, acute respiratory distress The questionnaire included three parts: basic information, syndrome, sepsis and septic shock, thromboembolism, and COVID-19-related information, and assessment of depressive multiorgan failure1. The impact of COVID-19 in China was state, sleep quality and diet. The final study population even greater than that of severe acute respiratory syndrome consisted of a total of 1,026 undergraduate students majoring in (SARS) in 2002. One study suggested that the SARS outbreak clinical medicine. showed a psychosocial influence on Chinese students, even though none of them became infected SARS (10). Depression Measurements accompanied major sleep problems in post-SARS syndrome was Basic Information reported (11). Insomnia was both a frequent symptom and a risk Demographic variables included gender (male or female), grade factor of depression (12). The positive relationships between a group (first grade, second grade, third grade, fourth grade, or fifth well-diet and sleep state and improved human health was also grade), age group (16–18, 19–21, 22–24, or 25–26 years), and documented (13). According to this evidence, we presume that location (five named provinces or other). Because more clinical the psychological condition, the sleep quality and the diet state of medicine students at Kunming Medical University were females medical students may be influenced by the COVID-19 outbreak. than males, more females than males were enrolled in the study. Although there have been many empirical studies about Because more students were from Yunnan Province, the number depression in medical students in China, few studies to date of students from five provinces, including Hubei, Guangdong, have conducted a survey on the depressive symptoms, the sleep Henan, Zhejiang and Hunan provinces, was significantly lower quality and the diet state of medical students at Kunming than the number of students from other provinces in China. The Medical University during the COVID-19 pneumonia outbreak. selection of these five provinces was based on the cumulative Therefore, the purpose of this study is to perform a cross- confirmed number of novel coronavirus pneumonia cases >1,000 sectional study of the prevalence and influencing factors of on February 22, 2020. depressive symptoms, sleep quality and diet during the early COVID-19 outbreak and to lay the groundwork for further Depressive Symptoms measures for at-risk medical students. The modified Chinese version of the Self-Rated Depression scale was used to evaluate the outcomes of depressive symptoms over the past 2 weeks. The scale was composed of 20 METHODS multiple choice questions. The total score ranged from 0 to Study Design and Participants 60, and a total score of >22 was defined as indicative of The study was designed to investigate the subjects’ depressive depressive symptoms. symptoms, sleep quality and diet. To select a representative Sleep Quality sample of respondents, we distributed an invitation to We used the modified Chinese version of the Pittsburgh Sleep clinical medical undergraduates to complete the web-based Quality Index scale to measure students’ sleep quality over the questionnaire. This web-based questionnaire was sent to the past 2 weeks. The total score ranged from 0 to 21, and a score >7 WeChat public platform. All invited students may see this was defined as indicative of poor sleep quality. questionnaire and may answer it by scanning the quick response code. This web-based survey was non-commercial, anonymous, State of Diet and completely voluntary. This was a cross-sectional design. The modified Chinese versionof the state of diet scale was applied We adopted a stratified sampling method to recruit the clinical to assess the students’ diet. The scale contained items on loss medical undergraduates of the University from students in of appetite, overeating, constipation, etc. The total score ranged the first, second, third, fourth and fifth grade. Non-clinical from0to15,andascore >5 was defined as indicative of poor diet. majors within the same university such as nursing and medical imaging were excluded. Students who met with the criteria Degree of Focusing on the COVID-19 or Concerned were all invited to complete the questionnaire. The estimated About Negative Impact of COVID-19 on Education or sample sizes required for the first, second, third, fourth and fifth Employment grade were respectively 167, 160, 164, 163, and 161. In total, A series of questions related to emotions were applied to assess 1026 respondents completed the questionnaire. The final sample the degree of focusing on the COVID-19 or concerned about composed of 244 (23.8%) first grade students, 182 (17.7%) second negative impact of COVID-19 on education or employment. The total score ranged from 0 to 20, and a score >6 was defined 1www.who.int/emergencies/diseases/novel-coronavirus-2019 as indicative of high degree of focusing on the COVID-19 or Frontiers in Public Health | www.frontiersin.org 2 January 2021 | Volume 8 | Article 588578 Xie et al. A Survey of Medical Students TABLE 1 | Demographic characteristics of study sample (N = 1,026).