The Depression And Anxiety Status And Influencing Factors Survey Of International Students During COVID-19 Outbreak Period In Hunan,China

Background: The outbreak of a novel coronavirus(COVID-19)was declared as a global pandemic by the World Health Organisation(WHO)in March 11,2020.The COVID-19 pandemic has disrupted not only lives,economies,and global supply chains but also mental health problems for people all over the world.In response to the COVID-19 epidemic,31 provinces and autonomous regions in China activated the level one public health emergency during the initial stage of the pandemic.Strict epidemiccontrol measures such as city lockdown,quarantine,suspension of social gatherings,closure of businesses,and delayed starting schools were implemented.Additionally,all educational institutions including universities and colleges in China were shut down.As a way to prevent the spread and transmission of the virus,international students in Hunan were quarantined in their dormitories while following preventive and control measures due to the implementation of lockdown(February-April 2020).Aim: The study aims to investigate the depression and anxiety status as well as influencing factors of international students during the COVID-19 outbreak lockdown in Hunan province.Methods: An online cross-sectional survey was conducted between May and June 2020.A snowball sampling technique was used to recruit participants in this study.Information of demographic characteristics,depression and anxiety status and other potential influencing factors such as sleep status,social support,coping strategies,and so on were collected using a questionnaire.Patient Health Questionnaire(PHQ-9)and Generalized Anxiety Disorder(GAD-7)were used to assess depression and anxiety status,respectively.Social Support Questionnaire(SSQ)and General Self-Efficacy Scale(GSE)were used to determine social support and coping strategies,respectively.Univariate and multivariate logistic regression analyses were used to investigate factors associated with depression and anxiety.Crude and adjusted odds ratio(OR)and 95%confidence interval(CI)were calculated.A p-value of less than 0.05 was considered statistically significant.Results: 450 participants completed the online survey and were included in the data analysis.The mean age was 25.49±3.95 years.The overall prevalence of depression and anxiety was 28.7% and 36.9%,respectively.From the multivariate logistic regression analyses,having suspected symptoms of COVID-19(a OR=3.54,95%CI=1.30-9.64)and having family members or friends infected with COVID-19(a OR= 1.51,95%CI=1.31-3.84)were positively associated with depression.Additionally,having 6-7 hours of sleep(a OR=4.02,95%CI=1.62-9.96)was also positively associated with depression.Regarding anxiety,being single(unmarried)was positively associated with anxiety(a OR=3.10,95%CI=1.46-6.57).Also,obtaining news or updates about the COVID-19daily(a OR=1.76,95%CI=1.13-3.75),using electronic devices for 5-6hours every day(a OR=2.21,95%CI=1.17-4.17),and having a sleep duration of 6-7 hours(a OR=2.65,95%CI=1.12-6.27)showed a positive association with anxiety.Furthermore,having high coping strategies was negatively associated with anxiety(a OR=0.33,95%CI=0.12-0.92).Most of the participants(95.7%)had less than 8 hours of sleep at night.Also,the majority of the students(86.7%)had high social support during the COVID-19 outbreak.Furthermore,most of them(91.8%)had high coping strategies.Conclusion: Although imposing lockdown and stay-in orders was an excellent measure to prevent the spread and transmission of the virus,they resulted in a high prevalence of depression and anxiety symptoms.In this study,we found that having suspected of COVID-19 symptoms,family members or friends infected with COVID-19,and 6-7 hours of sleep at night had a positive association with depression.Also,being single(unmarried),obtaining news or updates about the disease every day,using electronic devices for 5-6 hours,and 6-7 hours of sleep at night indicated a positive association with anxiety.Meanwhile,high coping strategies were found to have a negative association with anxiety.Therefore,mental health education and psychological support should be provided to this population during the pandemic or future epidemic diseases.Also,sleep hygiene should be promoted in colleges or universities,especially during outbreaks of epidemic diseases.Moreover,university authorities should also provide intervention programs promoting social support and coping strategies to students during outbreaks of epidemic diseases.13 Tables,83 References...