Table 1.
Characteristics of the included studies.
| Early stage (January–May 2020) | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| First author and year of publication | Survey time | Region | Sample size | Sample characteristics | Measurement tool (s) | Prevalence (%) of mental health problems |
Related risk factors | Protective factors | NOS quality | |||||
| Anxiety | Depression | Stress | PTSD | Insomnia | Other | |||||||||
| Chi et al., 2020b | Feb12 to Feb 17, 2020 | China | 2500 | M ± SD: 20.6 ± 1.90 Sex (f/m): 1283/755 |
Z-SAS, PHQ-9, PCL, PTGI |
15.5 | 23.3 | – | 30.8 | – | PTG = 66.9% |
Anxiety, Depression, and PTSD: older age, knowing people who had been isolated, more ACEs, higher level of anxious attachment and avoidant attachment, and lower level of resilience PTG: higher subjective SES, knowing people who had been isolated, and the number of confirmed cases in participants' areas, fewer ACEs, lower level of avoidant attachment, and higher level of resilience |
– | Satisfactory |
| Fu et al., 2020 | May 10 to Jun 10, 2020. | Haikou | 89,588 | Sex (f/m): 50,394/39,194 Age group: 18–30 years |
GAD-7 | 41.1 | – | – | – | – | – |
Anxiety: female, age (26–30 years), being a sophomore, junior, and senior student, higher paternal education level, low economic status, and low social support. |
Good | |
| Guan et al., 2021 | Feb4 to Feb 12, 2020 |
Henan | 24,678 | M ± SD: 20.51 ± 1.28 Sex(f/m): 11,048/13,630 |
GAD-7 | 7.3 | – | – | – | – | – |
Anxiety: Sex, place of residence, high worried and fear level, low cognitive level, and behavior status. |
Anxiety: positive preventing behaviors | Satisfactory |
| Jia et al., 2021 | Feb 2020 | China | 740 | Sex (f/m): 458/282 |
SAS | 18.78 | – | – | – | – | – | Anxiety: female | Anxiety: knowledge and attitude regarding COVID-19 | Satisfactory |
| Jing et al., 2021 | Feb20 to Feb 22, 2020 |
China | 17,876 | M ± SD: 54.8 ± 9.0 Sex(f/m): 12,818/5058 |
SDS | – | 65.2 | – | – | – | – | Depression: female, moderate or high self-perceived risk of infection, moderately or highly impacted by the outbreak, and eager to go back to school |
Depression:personality type, educational level, moderate or high concern about the outbreak, moderate or high satisfaction with pandemic prevention and control measures, and health literacy on communicable diseases |
Satisfactory |
| Li (Xueguo) et al., 2020 | Feb13 to Feb 22, 2020. |
Guangdong | 304,167 | Age range: 18–26 years Sex(f/m): 182065/122102 |
IES-6 | - | – | 50.9 | – | – | – |
Stress: perceptions of COVID-19, self-perceived mental health and sleep quality |
– | Good |
| Li (Mengyao) et al., 2020 | Mar 3 to Mar 15, 2020. |
China | 1676 | M ± SD: 20.17 ± 1.497 Sex(f/m): 1088/588 |
HAI | 24.3 | – | – | – | – | Panic = 17.2% |
Anxiety: perceived lethality, being affected by the global spread, and impact on social contacts |
Anxiety: Knowledge of prognosis, preventive measures, wearing masks, and trust in mainstream media Panic: understanding the risk of COVID-19 and felt Less affected. |
Satisfactory |
| Li (Xueyan) et al., 2021 | Apr26 to Apr 29, 2020. | Wuhan | 4355 | Sex (f/m): 2146/2209 |
PTSD (IES-6) | – | – | – | 16.3 | – | – | PTSD: family members suspected with COVID-19, lost a loved one due to COVID-19, and family income decreased, online course difficulties and the difficulties in adapting oneself to the online courses, excessive collection of personal information, estrangement of family relatives, and harassment and insult from strangers. | – | Satisfactory |
| Ma et al., 2020 | Feb3 to Feb 10, 2020. | Guangdong, Jiangxi Province, and Wuhan city | 746, 217 | Age range: 18–26 years Sex (f/m): 414,604/331,613 |
IES-6, PHQ-9, GAD-7 | 11.0 | 21.1 | 34.9 | – | – | – |
Anxiety: Senior students and those who smoked Anxiety and depression:confirmed or suspected cases in one's community or village, low perceived social support, and prior mental health problems Stress: >3 h exposure to media coverage of the COVID-19 each day |
– | Good |
| Meng et al., 2021 | Feb14 to Feb 21, 2020. |
All over China | 3351 | M ± SD: 21.18 ± 2.66 Sex (f/m): 2002/130 |
GAD-7, PHQ-9 |
6.88 | 10.50 | – | – | – | – |
Anxiety: COVID-19- related factors, such as a history of close contact with people under quarantine, fever or cough, and mask usage,need ways to regulate emotions, professional and psychological hotline, and psychiatric visits provided by schools Depression: Married, undergraduate and postgraduate, non-medical, and urban students, COVID-19-related factors, such as a fever or cough, and hours spent browsing COVID-19-related information, needed ways to regulate their emotions, used professional and psychological hotlines, and had psychiatric visits provided by schools |
Anxiety: need online curricula or books, information on prevention and self-protection, and real-time epidemic data of the school Depression: needed prevention and self-protection information provided by schools. |
Satisfactory |
| Song et al., 2021 | Feb 17 to Feb 23, 2020. |
Anhui | 1128 | Age range: 18–27 years Sex(f/m): 632/496 |
SAS,SDS, CPSS |
8.4 | 22.7 | 42.9 | – | – | – |
Depression and stress: Parents' annual income, education level, and sex. Anxiety, depression, and stress:family conflicts and specialty. |
– | Satisfactory |
| Sun et al., 2021a | Mar20 to Apr 10, 2020 | Various regions of China | 1912 | M ± SD: 20.28 ± 2.10 Sex (f/m); 1334/578 |
GAD-7, PHQ-9; IES-6 |
34.73 | 46.55 | 67.05 | – | – | – |
Anxiety: higher level of COVID-19 prosocial behavior, perceived threat and stigma due to COVID-19, and financial stress due to COVID-19. Depression: financial stress due to COVID-19, perceived threat and societal stigma due to COVID-19, and screen media device usage. Stress: financial stress due to COVID-9, and Perceived threat and societal stigma due to COVID-19. |
Anxiety and depression: mindfulness and social support | Satisfactory |
| Tang et al., 2020 | Feb20 to Feb 27, 2020. |
Chengdu and Chongqing | 2485 | Age range: 16–27 years Sex (f/m): 1525/960 M ± SD: 19.81 ± 1.55 |
PCL, PHQ-9 | – | 9.0 | – | 2.7 | – | – | Depression and PTSD: feeling extreme fear, short sleep duration, living in the worst-hit areas, and being a graduating/final year student. | – | Good |
| Wang (Xing) et al., 2020 | Feb21 to Mar 7, 2020 |
China | 3092 | Sex (f/m): 2054/1038 |
GAD-7, PSS-10, SRSS |
16.8 | – | 43.7 | – | – | Sleep problems = 13.5% |
Anxiety: reading daily news, having sleep problems, and high perceived stress Stress: anxiety symptoms and sleep problems. Sleep problems: Postgraduates, frequency of going out per week (1–3 times), and higher perceived stress. |
Anxiety: carelessness with the number of remaining masks Sleep problems: frequency of daily news reading (1–3 times). Stress: higher frequency of daily news reading (4–7 times) and number of remaining masks (more than 20). |
Satisfactory |
| Wang (Zheng-He) et al., 2020 | Jan 31 to Feb 5, 2020. |
Guangzhou | 44,447 | Age group: 16–50 years M ± SD: 21.0 ± 2.4 Sex (f/m): 24,230/20,217 |
Z-SAS, CES-D |
7.7 | 12.2 | – | – | – | – |
Depression: lived in province where cumulative number of confirmed cases range from 1000 to 9999, have family members and relatives confirmed and suspected with COVID-19 Anxiety and depression: cumulative number of confirmed cases in the provinces; having infected family members and relatives or not, self-reported health condition, and education level. |
Anxiety and depression: postgraduate | Satisfactory |
| Wu et al., 2021 | Feb 4 to Feb 12, 2020 | China | 11,787 | M ± SD: 20.45 ± 1.76 Sex (f/m): 6731/5056 |
GAD-7, PHQ-9 |
17.8 | 25.9 | – | – | – | – | Anxiety and depression: history of residence in or travel to Wuhan in the past month, residing in Wuhan city, college location in Wuhan, and living in areas with a median number (200–600, >1000) of confirmed COVID-19 cases | – | Good |
| Xiang et al., 2020 | Feb 25 to Mar 5, 2020. |
China | 1396 | M ± SD: 20.68 ± 1.84 Sex(f/m): 515/881 |
SAS, SDS | 31.0 | 41.8 | – | – | – | – |
Anxiety: lived in an only child family Depression: female and undergraduate. |
Anxiety: high level of physical activity (stretching and resistance training), Depression: moderate or high level of physical activity, (household chores and stretching) |
Satisfactory |
| Xiong et al., 2021 | Feb 20 to Mar 20, 2020 |
Guangdong | 563 | M±SD: 21.52 ± 2.50. Sex(f/m): 391/172 |
DASS-21 | Moderate to severe = 18.47 | Moderate to severe = 12.26 | Moderate to severe 8.53 | – | – | – |
Anxiety: mindful coping. Anxiety and depression: negative emotions, prevention of mindful coping Anxiety and stress: awareness and negative emotions prevention of mindful coping. |
– | Satisfactory |
| Yang et al., 2021 | Apr to May 2020 | Sichuan | 521 | M ± SD: 22.02 ± 1.761 Sex(f/m): 404/117 |
SAS | Mild = 31.5 Moderate = 8.1 Severe = 5.8 |
– | – | – | – | Distress = 19.0% |
Anxiety: medical student, paying attention to pandemic information (frequency of >10 times a day) Distress: medical student and general health status |
Distress: age (above 22 years) |
Satisfactory |
| Yu (Chang) et al., 2021 | Feb 15 to Feb 22, 2020. |
China | 1086 | Sex(f/m): 737/349 Age range: 18–60 years |
AIS, SRQ-20, CPSS | - | – | 40.70 | 16.67 | General psychological symptoms = 5.8% |
Insomnia: female, general psychological symptoms and living in an isolation unit. |
– | Satisfactory | |
| Yu (Mingli) et al., 2021 | Mar 3 to Mar 15, 2020 |
Various regions of China | 1681 | Sex (f/m): 1089/592 |
CES-D | – | 56.8 | – | – | – | – | Depression: sleep problems, family members' going out, perceived more stress for online education, fear of COVID-19, influence on social interaction and higher grades. |
Depression: Perceived social support, hope, female, and higher monthly disposable income. |
Satisfactory |
| Yu (Yanqiu) et al., 2021 | Feb1 to Feb 10, 2020. |
China | 23,863 | Sex (f/m): 16,258/7605 |
PHQ-9 | – | 39.1 | – | – | – | Mental distress: 47.1% |
Depression: mental distress due to COVID-19, number of confirmed cases (>300 cases) detected in the province Depression and mental distress: perceived infection risk, having close contacts with people who had visited Wuhan 2 weeks prior to the CNY, perceived discrimination due to COVID-19. |
Depression: staying in the city of the university, staying with family, and self-perceived physical health, | Satisfactory |
| Zhang (Xudong) et al., 2021 | Feb21 to Feb 24, 2020, |
China | 2270 | Age range: 18–25 years Sex (f/m): 1393/877 |
SAS, SDS | 8.2 | 21.0 | – | – | – | – |
Anxiety and depression: contact history of similar infectious disease, past medical history, and compulsive behaviors |
Anxiety and depression: Older students, regular daily life during the epidemic outbreak, exercise during the epidemic outbreak, and concerns related to COVID-19 | Satisfactory |
|
Zhou et al., 2020 |
Mar 1 to Mar 15, 2020, |
China |
11133 |
Age range: 18–35years Median = 21 Sex(f/m): 6938/4195 |
PHQ-9, GAD-7 |
24.9 |
37.0 |
– |
– |
– |
Suicidal ideation = 7.3% |
Anxiety and depression: female, graduate students, and those with COVID-19 exposure Suicidal ideation: anxiety and depressive symptoms |
Anxiety and depression: living with Parents, being familiar with COVID-19, actively taking preventive and control measures, and being optimistic about projections of COVID-19 |
Good |
| Normalization stage (June 2020∼current) | ||||||||||||||
|
First author and year of publication |
Time period |
Region |
Sample size |
Sample characteristics |
Measurement tool (s) |
Prevalence (%) of mental health problems |
Related risk factors |
Protective factors |
NOS quality |
|||||
|
Anxiety |
Depression |
Stress |
PTSD |
Insomnia |
Other |
|||||||||
| Ren et al., 2021 | Sept 14 to Sept 20,2020 | Shandong | 478 | Sex(f/m): 273/205 |
SAS, PHQ-9 | 15.5 | 32.4 | – | – | – | – |
Anxiety: taking temperature routinely, retaining holiday, taking the final examination after school reopening, lockdown restriction, exercise frequency, quarantine of classmates, take-out availability, alcohol use, availability of package delivery, school reopening, self-quarantine after school reopening, and the degree to which family economic status is influenced by COVID-19) Depression: routinely wearing masks, having relatives or friends who have been infected, satisfaction with living conditions in the school, several areas in school being closed due to COVID-19, self-rated sleep quality, lockdown restriction, exercise frequency, quarantine of classmates, alcohol use, self-quarantine after school reopening, and the degree to which family economic status is influenced by COVID-19) |
– | Satisfactory |
| Wang (Dongfang) et al., 2021 | Jun 1 to Jun 15, 2020 |
Guangdong | 8921 | Age range: 16–25 years M ± SD: 21.59 ± 1.81 Sex (f/m): 5857/3064 |
PHQ-9, GAD-7, IES-6, YSIS | 4.2 | 8.7 | 10.5 | – | 6.1 | – |
Stress: male gender, living in rural areas, or living with siblings. Anxiety, depression, and insomnia: history of psychiatric conditions Poor mental health: Sophomore, history of psychiatric conditions, and impacted academic activities and social communication |
Good | |
| Xu et al., 2021 | Jun 29 to Jul 18, 2020 |
Wuhan | 11,254 | Sex (f/m): 7200/4054 Age range: 15–20 years |
PHQ-9, GAD-7, ISI, PCL-5, | 32.6 | 41.5 | – | 8.5 | 35.0 | Suicidal behavior: 2.0% |
Mental health problems: positive family history of psychosis, and prior history of mental illness, distant relationship with parents, and changes in lifestyle and alcohol use Suicidal behavior: female, high stress, changes in lifestyle and alcohol use, and high stress |
Mental health problems: regular physical exercise, | Good |
| Yu (Jincong) et al., 2021 | Jul to Aug 2020 |
Wuhan | 9383 | Sex(f/m): 6698/2685 |
PHQ-9 | – | 15.8 | – | – | – | – |
Anxiety: academic stress and concerns about the epidemic Depression: experience of being quarantined for observation or treatment, family members or friends dying of COVID-19, rarely or never seeking help from others, fewer supportive relatives or friends, less support from family in the past month, a worse relationship with parents at home, a longer time spent daily on electronic devices except for online learning, and feeling anxious in the face of returning to school. |
– | Good |
| Zhang (Yifan) et al., 2021 | Jun1 to Jun 15, 2020 |
Guangdong | 146,102 | Age range: 16–25 years Sex(f/m): 90,701/55,401 |
YSIS | – | – | – | – | 16.9 | – |
Insomnia: female, living in urban area, having a history of physical illness, or suffering depressive and anxiety symptoms. |
Insomnia: College senior degree and 7–8 h' sleep duration per day | Good |
| Zheng et al., 2021 | Dec17 to Dec 19, 2020. |
Shandong | 954 | M ± SD: 21.1 ± 1.2 Age range = 18–28 years Sex(f/m): 588/366 |
PHQ-9, GAD-7, ISI. | 34.6 | 50.2 | – | 25.3 | – |
Anxiety: age Depression: age and living in rural areas Anxiety and depression: female and native of non-Shandong |
– | Satisfactory | |
Age was expressed as M ± SD: Mean age ± Standard deviation or range. Sex as (f/m): female/male. CS: Cross-sectional study.
PHQ-9: Patient Health Questionnaire −9, GAD-7: Generalized Anxiety Disorder-7, SDS: Self-Rating Depression Scale, SAS: Self-Rating Anxiety Scale, CES-D: Center for Epidemiologic Studies Depression Scale, Z-SAS: Zung's Self-rating Anxiety Scale, HAI: Health Anxiety Inventory subscale, CPSS:Chinese perceived stress scale, PSS-10: Perceived Stress Scale, DASS-21: Depression, Anxiety, and Stress Scale, IES-6: Impact of Event Scale 6-Item, YSIS:Youth Self-Rating Insomnia Scale, ISI: Insomnia Severity Index, AIS: Athens Insomnia Scale. PTSD: Post Traumatic Stress Disorder, PCL: PTSD Checklist, PCL-5: Post-traumatic Stress Disorder Checklist for DSM-5, PTGI: post-traumatic Growth Inventory, and SRQ-20: Self-Reporting Questionnaire-20. SRSS: Self-Rating Scale of Sleep.