COVID-19-Related Intolerance of Uncertainty and Mental Health among Back-To-School Students in Wuhan: The Moderation Effect of Social Support

Trait and situation-specific intolerance of uncertainty predict affective symptoms during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic, a high-uncertainty situation, presents an ideal opportunity to examine how trait intolerance of uncertainty (IU) and situation-specific IU relate to each other and to mental health outcomes. The current longitudinal study examined the unique associations of trait and COVID-specific IU with general distress (anxiety and depression) and pandemic-specific concerns (pandemic stress and vaccine worry).

METHODS

A community sample of Florida adults (N = 2152) was surveyed online at three timepoints. They completed measures of trait IU at Wave 1 (April-May 2020) and COVID-specific IU at Wave 2 (May-June 2020). At Wave 3 (December-February 2021), they reported symptoms of depression, anxiety, pandemic stress, and vaccine worry.

RESULTS

We used structural equation modeling to test our overall model. Trait IU significantly predicted later COVID-specific IU, however there was no significant effect of trait IU on any outcome measure after accounting for COVID-specific IU. Notably, COVID-specific IU fully mediated the relationship between trait IU and all four symptom measures.

LIMITATIONS

There were several limitations of the current study, including the use of a community sample and high participant attrition.

CONCLUSIONS

Results suggest that COVID-specific IU predicts mental health outcomes over and above trait IU, extending the existing literature. These findings indicate that uncertainty may be more aversive when it is related to specific distressing situations, providing guidance for developing more specific and individualized interventions. Idiographic treatments which target situation-specific IU may be more efficacious in reducing affective symptoms and related stress during the COVID-19 pandemic or other similar events.

Intolerance of uncertainty and mental health in China "Post-pandemic" age: The mediating role of difficulties in emotion regulation

The Chinese government adjusted its national epidemic prevention and control policy in December 2022 after the worldwide declaration of COVID-19 as a common influenza. After the policy adjustment, there has been widespread infection in China, which has brought a lot of uncertainty to the lives and studies of Chinese university students. This study focused on the impact of the intolerance of uncertainty for COVID-19 (IUC) on the emotional and mental health of college students in China "Post-pandemic" age. This study examined the mediating role of difficulties in emotion regulation (DER) between IUC and mental health (MH). 1,281 university students in China were surveyed using the intolerance of uncertainty for COVID-19 scale, the difficulties in emotion regulation scale and the mental health scale. A structural equation model was used to test the hypothesis model, and it was shown that IUC had a significant negative effect on the MH of college students and a significant positive effect on the DER. DER had a significant negative effect on the MH, and DER had a complete mediation effect between IUC and MH. The findings of this study enrich our understanding of the influencing factors of mental health of university students under the background of post-epidemic in China, and provide practical reference for universities on how to prevent mental health problems under the current uncertain environment in China.

The Use of Social Media to Express and Manage Medical Uncertainty in Dyskeratosis Congenita: Content Analysis

BACKGROUND

Social media has the potential to provide social support for rare disease communities; however, little is known about the use of social media for the expression of medical uncertainty, a common feature of rare diseases.

OBJECTIVE

This study aims to evaluate the expression of medical uncertainty on social media in the context of dyskeratosis congenita, a rare cancer-prone inherited bone marrow failure and telomere biology disorder (TBD).

METHODS

We performed a content analysis of uncertainty-related posts on Facebook and Twitter managed by Team Telomere, a patient advocacy group for this rare disease. We assessed the frequency of uncertainty-related posts, uncertainty sources, issues, and management and associations between uncertainty and social support.

RESULTS

Across all TBD social media platforms, 45.98% (1269/2760) of posts were uncertainty related. Uncertainty-related posts authored by Team Telomere on Twitter focused on scientific (306/434, 70.5%) or personal (230/434, 53%) issues and reflected uncertainty arising from probability, ambiguity, or complexity. Uncertainty-related posts in conversations among patients and caregivers in the Facebook community group focused on scientific (429/511, 84%), personal (157/511, 30.7%), and practical (114/511, 22.3%) issues, many of which were related to prognostic unknowns. Both platforms suggested uncertainty management strategies that focused on information sharing and community building. Posts reflecting response-focused uncertainty management strategies (eg, emotional regulation) were more frequent on Twitter compared with the Facebook community group (χ21=3.9; P=.05), whereas posts reflecting uncertainty-focused management strategies (eg, ordering information) were more frequent in the Facebook community group compared with Twitter (χ21=55.1; P<.001). In the Facebook community group, only 36% (184/511) of members created posts during the study period, and those who created posts did so with a low frequency (median 3, IQR 1-7 posts). Analysis of post creator characteristics suggested that most users of TBD social media are White, female, and parents of patients with dyskeratosis congenita.

CONCLUSIONS

Although uncertainty is a pervasive and multifactorial issue in TBDs, our findings suggest that the discussion of medical uncertainty on TBD social media is largely limited to brief exchanges about scientific, personal, or practical issues rather than ongoing supportive conversation. The nature of uncertainty-related conversations also varied by user group: patients and caregivers used social media primarily to discuss scientific uncertainties (eg, regarding prognosis), form social connections, or exchange advice on accessing and organizing medical care, whereas Team Telomere used social media to express scientific and personal issues of uncertainty and to address the emotional impact of uncertainty. The higher involvement of female parents on TBD social media suggests a potentially greater burden of uncertainty management among mothers compared with other groups. Further research is needed to understand the dynamics of social media engagement to manage medical uncertainty in the TBD community.

The impact of core self-evaluation on school adaptation of high school students after their return to school during the COVID-19 pandemic: the parallel mediation of positive and negative coping styles

Background

To explore the direct effect of core self-evaluation and the indirect effects of positive and negative coping styles on school adaptation of high school students after their return to school during the COVID-19 pandemic.

Methods

The Core Self-Evaluation Scale, Simple Coping Style Scale, and School Adaptation Questionnaire were used for the psychometric analysis of 500 high school students (229 males and 271 females) one month after their return to school. The bootstrap method was applied for mediation analysis.

Results

A positive correlation was noted between core self-evaluation and school adaptation (r = 0.56), and the predictive effect was significant (β = 0.43). Core self-evaluation positively predicted positive coping styles, which positively predicted school adaptation, while core self-evaluation negatively predicted negative coping styles, which negatively predicted school adaptation. Positive and negative coping styles played a significant mediating role between core self-evaluation and school adaptation. The mediating effect included the indirect effects generated by two pathways: core self-evaluation → positive coping style → school adaptation (95% CI [0.08-0.19]) and core self-evaluation → negative coping style → school adaptation (95% CI [0.03-0.11]).

Conclusion

There is a positive association between the core self-evaluation and school adaptation of high school students after their return to school during the COVID-19 pandemic. It may directly or indirectly affect the school adaptation of high school students after their return to school through positive or negative coping styles. After returning to school, educators should guide students to view themselves positively, cultivate healthy core self-evaluation, and enable them to have good school adaptation.

Uncertainty as a driver of the youth mental health crisis

Mental health problems in young people have been on the rise for over a decade, with that trend accelerating during the pandemic. This review proposes that the catalyst effect of the pandemic offers insights into a key driver of increases in youth depression and anxiety: greater uncertainty. Uncertainty about many aspects of everyday life, including social connections, education, job security and health, increased during the pandemic, and this coincided with increasing rates of depression and anxiety. Lab-based developmental cognitive and clinical neuroscience research on tolerance of uncertainty and adolescent mental health shows that when adolescents fail to show age-typical tolerance of uncertainty, they are at greater risk of mental health problems. Avenues for future research to understand and promote tolerance of uncertainty in adolescents are proposed.

Profiles of Intolerance of Uncertainty Among 108,540 Adolescents: Associations with Sociodemographic Variables and Mental Health

Intolerance of uncertainty (IU) is widely considered a transdiagnostic risk and maintaining factor for psychiatric disorders. However, little is known about the overall nature and profile of IU among adolescents. This study aims to investigate the profiles of IU among Chinese adolescents and explore their associations with sociodemographic characteristics and mental health problems. A sample of 108,540 adolescents provided data on IU, sociodemographic characteristics, and mental health via an online platform. Latent profile analysis revealed three profiles: Low IU, Medium IU, and High IU. Girls, older adolescents, and those with specific sociodemographics were more likely to belong to the "High IU" profile. Furthermore, the "High IU" profile was associated with the highest risk of several mental health problems. These findings provided valuable information for early prevention and intervention strategies targeting IU and highlighted the importance of IU-based interventions for mental health among adolescents.

Short report: COVID-19 related knowledge, anxiety, and attitude towards the back-to-school arrangement among college students in China: a cross-sectional study

The coronavirus disease 2019 (COVID-19) pandemic has been assumed to affect mental health of college students. The present cross-sectional study was conducted to examine levels of knowledge and anxiety about COVID-19, as well as attitude towards the back-to-school arrangement among college students in China in May 2020. A total of 716 students (312 males, 404 females) were included. Only 38.1% of the participants showed good knowledge about COVID-19. Moderate and severe anxiety was observed among 7.6% of the students. There were 15.6% of the participants opposing the back-to-school arrangement. Female students had more risk of having anxiety symptoms and negative attitude towards the back-to-school arrangement (p < 0.05). In addition, the level of anxiety was positively associated with the negative attitude towards the back-to-school arrangement (r = 0.11, p < 0.05). We therefore suggest that health education and psychological interventions should be given to college students, especially females and those without health-related backgrounds during the COVID-19 pandemic.

International students' collective resilience in crisis: Sense of community reduced anxiety via social contact and social support during lockdown

Objectives

The role of community in individuals' well-being has been extensively examined in the Western context. However, little is known about how the host community is related to sojourners' well-being in a crisis in an Asian context. The current study aims at exploring international students' sense of community in the Chinese context under the direct threat of a global health crisis.

Methods

Using a cross-sectional sample of 102 international students staying in Wuhan during the 76-day lockdown at the earliest stage of the COVID-19 pandemic, the current study explored the relationship between international students' sense of community and anxiety, and the mediating role of social contact, social support from three key sources in the host community (host university, international students, and Chinese friends).

Results

Results showed that participants' stronger sense of community indirectly reduced anxiety via the role of sources of contact and support from the host community.

Conclusions

This study provided further evidence to support the nurturance of the sense of community in community resilience and provided implications on how the host community can help to enhance sojourners' psychological well-being in a global crisis.

Impact of Social Support on Depressive Symptoms among Postgraduates during the Coronavirus Disease 2019 Pandemic: A Moderated Mediation Analysis

The coronavirus disease (COVID-19) pandemic continues to spread worldwide, and its related stressors are causing a high prevalence of mental health problems among graduate students. This has the potential for long-term effects on their mental well-being. However, few large-scale studies have been conducted on multiple risk and protective factors. Therefore, we aimed to test the impact of social support on depressive symptoms among graduate students and analyze the mediating role of positive coping and the regulatory role of neuroticism. From 1-8 October 2021, 1812 Chinese graduate students were surveyed online. We used a structural equation model to study the mediating role of positive coping in the relationship between social support and depressive symptoms and used the Hayes PROCESS macro to conduct mediating analysis. The incidence of depressive symptoms was 10.40%. These results showed that positive coping influenced the social support's influence on depression symptoms to some extent. Moreover, neuroticism regulates the indirect relationship between social support and depressive symptoms through active coping. Further research is needed to assess the impact of various forms of social support on graduate students' mental health and to develop strategies for maintaining their well-being, such as network mindfulness.

The Association of Social Support and Loneliness with Symptoms of Depression, Anxiety, and Posttraumatic Stress during the COVID-19 Pandemic: A Meta-Analysis

BACKGROUND

Research suggests that changes in social support and loneliness have affected mental disorder symptoms during the COVID-19 pandemic. However, there are a lack of studies comparing the robustness of these associations.

AIMS

The aims were to estimate the strength of the associations of loneliness and social support with symptoms of depression, anxiety, and posttraumatic stress during the COVID-19 pandemic (2020-2022) in the general population.

METHOD

The method entailed a systematic review and random-effects meta-analysis of quantitative studies.

RESULTS

Seventy-three studies were included in the meta-analysis. The pooled correlations of the effect size of the association of loneliness with symptoms of depression, anxiety, and posttraumatic stress were 0.49, 0.40, and 0.38, respectively. The corresponding figures for social support were 0.29, 0.19, and 0.18, respectively. Subgroup analyses revealed that the strength of some associations could be influenced by the sociodemographic characteristics of the study samples, such as age, gender, region, and COVID-19 stringency index, and by methodological moderators, such as sample size, collection date, methodological quality, and the measurement scales.

CONCLUSIONS

Social support had a weak association with mental disorder symptoms during the COVID-19 pandemic while the association with loneliness was moderate. Strategies to address loneliness could be highly effective in reducing the impact of the pandemic on social relationships and mental health.

Mental health status among non-medical college students returning to school during the COVID-19 pandemic in Zhanjiang city: A cross-sectional study

The coronavirus disease-2019 (COVID-19) pandemic has brought huge and continuous damage to mental health. The mental health of non-medical college students after returning to school remains largely unknown and the influencing factors were awaited to be deciphered. This cross-sectional study was launched among 1,083 non-medical students in Zhanjiang city by means of online survey (WeChat App) from August 1st, 2022 to August 7th, 2022. Knowledge about COVID-19 and attitude toward COVID-19 were assessed by using 7-items and 5-items questionnaires, respectively. Sleep quality, anxiety and depression symptoms were evaluated by Pittsburgh sleep quality index (PSQI), Hamilton depression rating scale-17 (HDRS-17) and self-rating anxiety scale (SAS), respectively. The results showed that more than half of the participants were knowledgeable about COVID-19. The majority of the participants held positive attitude toward COVID-19. The data demonstrated that 6.8% students had poor sleep quality, and 1.86, 0.37 and 0.37% students had mild, moderate and severe anxiety, respectively. About 26.7, 4.7 and 1.7% students had minimal, mild-moderate and severe depression. Female students showed higher proportions of anxiety (p = 0.02) and depression (p < 0.0001) than male students. Students with monthly household income below 3,000 RMB were more vulnerable to anxiety (p = 0.017) and depression (p = 0.004). Correlation analysis and Multivariate logistic regression analysis results showed that lower grade was positively related with anxiety and depression. Female students, income lower than 3,000 RMB/month, poor knowledge about COVID-19 and negative attitude toward COVID-19 were associated with insomnia, anxiety and depression. This study indicated that during the COVID-19 pandemic, a majority of non-medical students returning to school remained good sleep quality and a small number of students suffered from depression and anxiety. To our knowledge, this is a novel study revealing the mental health of non-medical college students concerning COVID-19 in Zhanjiang.

How Parental Support Affects Latina Girls During the COVID-19 Pandemic

Abstract. The current study focuses on a sample of low- to middle-income school-age Latina girls and their parents and examines how children’s distress proneness interacts with parental empathic accuracy and posttraumatic growth in the wake of the COVID-19 pandemic to predict children’s empathy and prosocial behavior toward unknown others. Approximately 2–3 months into state-mandated stay-at-home orders, 55 parent–daughter dyads were recruited to participate in this four-session longitudinal study. To assess distress proneness, daughters (ages 8–13 years, 100% Latina) identified their degree of distress in response to pandemic-related stressors. Concurrently, their parents reported how they thought their children would respond to these same pandemic-related stressors, which assessed parental empathic accuracy. Parents also completed an adapted version of the Posttraumatic Growth Inventory, which assessed perceived positive outcomes of the COVID-19 pandemic. Upon study completion, a behavioral measure of children’s empathic and prosocial behaviors was collected. Parental empathic accuracy interacted with children’s distress proneness to positively predict children’s affective empathy, such that children’s distress proneness predicted affective empathy at high and mean, but not low, levels of parental empathic accuracy. In a separate analysis, parental posttraumatic growth interacted with children’s distress proneness to positively predict children’s altruistic sharing behavior, such that children’s distress proneness predicted altruistic sharing behavior only at high, but not mean or low, levels of parental posttraumatic growth. The results of this study highlight how positive parental socialization and understanding of children’s tendencies toward distress are associated with children’s empathic and prosocial behaviors, particularly during major global crises.

Mental Health among Young Adults during the COVID-19 Pandemic: A Two-Wave Longitudinal Investigation

This study aimed to assess changes in COVID-19 related factors (i.e. risk perception, knowledge about the virus, preventive behaviors and perceived efficacy) and mental health (i.e. psychological distress and positive mental health), in a sample of Romanian young adults attending college, assessed immediately after the national COVID-19 lockdown ended (Time 1) and six months after the end of the lockdown (Time 2). We also evaluated the longitudinal relations between COVID-19 related factors and mental health. The sample consisted of 289 undergraduate students (89.3% female, Mage = 20.74, SD = 1.06), who completed questionnaires assessing mental health and COVID-19-related factors via two online surveys, six months apart. The results showed that perceived efficacy and preventive behaviors, as well as positive mental health, but not psychological distress, decreased significantly over the six months period. Risk perception and perceived efficacy of preventive behaviors at Time 1 were positively related with the number of preventive behaviors measured six months later. Risk perception at Time 1 and fear of COVID-19 at Time 2 predicted the mental health indicators at Time 2. Public-health strategies should find the right balance in cultivating proper levels of risk perception that would be most beneficial for prevention of COVID-19 spread and mental health problems due to pandemic.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

OBJECTIVE

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.

METHODS

Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.

RESULTS

A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQI_gen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQI_gen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality.

CONCLUSIONS

We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

The Application of the Intolerance of Uncertainty Model to Gambling Urge and Involvement

BACKGROUND

Drawing on the intolerance of uncertainty model, this study aimed to examine whether intolerance of uncertainty and emotion regulation difficulties (in terms of impulse control difficulties and limited access to emotion regulation strategies) contributed to individual differences in gambling urge and involvement.

METHODS

Convenience sampling was used to recruit Chinese adult participants who had engaged in buying lottery tickets and other gambling activities in the past year. They were asked to complete an anonymous questionnaire survey, and a total of 580 valid cases (M_age = 34.07, SD = 13.36; 50.4% female) were collected for data analysis.

RESULTS

Path analysis showed that the total effect of intolerance of uncertainty on gambling urge and involvement was significant and positive. However, only impulse control difficulties and not limited access to emotion regulation strategies fully mediated the effect of intolerance of uncertainty.

CONCLUSIONS

As the first study to apply the intolerance of uncertainty model to real-life gambling, it found that individuals' intolerance of uncertainty and impulse control difficulties contributed to more gambling urge and involvement. Improving emotion regulation skill (e.g., impulse control training) may, therefore, be considered in programs for promoting responsible gambling among Chinese gamblers.

Prevalence and associated influential factors of mental health problems among Chinese college students during different stages of COVID-19 pandemic: A systematic review

This systematic review aims to take China as an example to determine the prevalence of mental health problems and associated influential factors of college students in different stages of the COVID-19 pandemic and provide a reference for effective intervention in the future. A systematic search was conducted on PubMed, Web of Science, Scopus, Science Direct, and Google scholar. A total of 30 articles were included. 1,477,923 Chinese college students were surveyed. In the early stage, the prevalence rates of depression, anxiety, stress, and PTSD ranged from 9.0% to 65.2%, 6.88%-41.1%, 8.53%-67.05%, and 2.7%-30.8%, respectively. Major risk factors were being a female, a medical student, isolation or quarantine, having family members or friends infected with COVID-19, and challenges of online learning. During the normalization stage, depression, anxiety, and insomnia prevalence rates ranged from 8.7% to 50.2%, 4.2%-34.6%, and 6.1%-35.0%, respectively. The main risk factors were self-quarantined after school reopening, regular taking temperature, and wearing face masks. The prevalence rates of mental health problems and associated influential factors unveiled in both stages showed that the students' mental health status was greatly affected. Therefore, a combination of efforts from the government, universities, and families or communities is highly needed to alleviate the mental health sufferings of students.

Fear of COVID-19 and the career maturity of Chinese international high school students: The mediating effect of the intolerance of uncertainty

This study examined the influencing mechanism underlying the relationship between the fear of COVID-19 and Chinese international high school students' career maturity by investigating the mediating role of the intolerance of uncertainty. The results indicated that the fear of COVID-19 and the intolerance of uncertainty are negatively associated with international high school students' career maturity. Moreover, intolerance of uncertainty plays a mediating role in the relationship between the fear of COVID-19 and career maturity. The findings contribute to the literature on mental health and have important practical implications for international high school students' mental health and career development.

The impact of psychological hardiness on intolerance of uncertainty in university students during the COVID-19 pandemic

The purpose of the study was to measure the impact of psychological hardiness on the intolerance of uncertainty (IOU) among university students during the coronavirus disease 2019 (COVID-19) pandemic. A cross-sectional correlational research design was used in the study, where participants were selected by convenience sampling. The data was collected from 1217 undergraduate students from a university in Turkey through web-based questionnaires. The Intolerance of Uncertainty Scale assessed data, including intolerance of uncertainty. In addition, the Personal Views Survey III-R was used to measure students' psychological hardiness. The results indicated that Turkish undergraduate students overall had high IOU and above-average psychological hardiness. Psychological hardiness was negatively correlated with IOU. Students losing a loved one because of COVID-19 had increased intolerance to uncertainty and lower psychological hardiness. Psychological hardiness was a powerful predictor of IOU. These findings show the need to implement hardiness-training programs for undergraduate students to increase their tolerance to uncertainty and reduce the effect of grief.

A, Neelakantan M. The role of classroom engagement on academic grit, intolerance to uncertainty and well-being among school students during the second wave of the COVID-19 pandemic in India

The forced changes and disruptions in educational systems and learning experiences due to the pandemic has impacted students' mental health and well-being. The present study aims to understand the effects of the determinants of well-being on students in India during the second wave (April to August 2021) of the COVID-19 pandemic. The determinants of well-being in this study are academic grit, intolerance to uncertainty and students' engagement in an online learning environment. In this study, well-being is characterized as students' confidence and satisfaction in an online learning and pandemic environment. The data collected from 1174 students (12-19 years) from various states, using standardized tools, were analyzed to find out about the mediating effect of students' engagement on the relationship between academic grit and well-being, and between intolerance to uncertainty and well-being. Further, the model fit analysis of the determinants of well-being is explored. The paper reports that students' classroom engagement does mediate in the path of academic grit and well-being, and in the path of intolerance to uncertainty and well-being. It also evidence the model fit of the influence of the determinants of well-being on that of school students during the second wave of the COVID-19 pandemic. The study also draws implications and suggestions for educators using the current model of students' well-being.

Interventions in Chinese Undergraduate Students' Mental Health: Systematic Review

BACKGROUND

Over 30% of university students from 8 countries were afflicted with mental distress according to a World Health Organization survey. Undergraduate students in increasing numbers in China have also been reported to suffer from different mental problems. Various psychological distresses significantly impact their academic and daily life, thereby causing role impairments and unsatisfactory academic achievements. While the prevalence of, diverse underlying factors for, and interventions of social support in college students' mental health have extensively been investigated in China, there is no study exclusively focusing on the impact of interventions on their psychological well-being.

OBJECTIVE

The aim of this review was to identify and synthesize the interventions in the mental health concerns of Chinese undergraduate students studying in China reported in the literature to inform educational authorities, college and university management, students' affairs counselors, and mental health providers.

METHODS

We performed a systematic review and reported the research findings of previous studies according to the protocol of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. First, based on the predefined search strategy, keyword searches were performed in the PubMed and ProQuest databases to retrieve relevant studies. Subsequently, we screened the candidate articles based on predefined inclusion and exclusion criteria. Finally, we analyzed the included papers for qualitative synthesis.

RESULTS

We retrieved a total of 675 studies from the PubMed and ProQuest databases using the search strategy on March 15, 2022. Among these candidate studies, 15 that were not written in English, 76 duplicates, and 149 studies of other document types were removed before screening. An additional 313 studies were excluded in the screening process, with 73 articles ruled out for being not relevant to interventions, not related to mental health, or not focused on undergraduate students in the full-text review. As a result, 49 papers were eligible and included in this systematic review. In the qualitative synthesis, we divided the interventions reported in the selected studies into two categories: (1) social support from government authorities, university authorities, students' affairs counselors and teachers, family members, health care authorities and professionals, and the media (various online platforms), and (2) various coping strategies adopted by undergraduate students themselves. We identified further research on mental health interventions that may be delivered by digital medical platforms, conversational agents (eg, chatbots), and researchers.

CONCLUSIONS

This was the first systematic review of interventions to address the mental health concerns of Chinese undergraduate students studying in China. The categorization of reported interventions and the identification of new intervention channels can effectively inform stakeholders. Interventions for undergraduate students' mental health is a research topic worth further investigation.

Effects of Negative Emotions and Cognitive Characteristics on Impulse Buying During COVID-19

The COVID-19 pandemic has seriously disrupted the individual buying habits along with their consumption patterns. Previous studies indicated that anxiety and depression were related to impulse buying. However, no research has explored the mechanism possibly underlying the association between anxiety, depression, and impulse buying. Based on the regulatory focus theory and the emotion-cognition-behavior loop, this study aimed to examine the impacts of negative emotions on impulse buying and the mediating role of cognitive characteristics during the COVID-19 pandemic. In April 2021, 734 Chinese undergraduates were recruited by cluster sampling and they completed self-report measures of anxiety, depression, intolerance of uncertainty, cognitive flexibility, and impulse buying. Results showed that impulse buying was positively associated with anxiety, depression, and intolerance of uncertainty, while it was negatively associated with cognitive flexibility. Cognitive flexibility fully mediated the effects of anxiety and depression on cognitive facet of impulse buying. Meanwhile, intolerance of uncertainty fully mediated the effects of anxiety and depression on affective facet of impulse buying. Overall, this study shows that different pathways can explain how anxiety and depression exacerbate two aspects of impulse buying, and it highlights the importance of cognitive characteristics for the link between negative emotions and impulse buying. Intervention programs should focus on increasing cognitive flexibility and tolerance to uncertainty of high-risk individuals, so as to strengthen their adaptive purchase behaviors.

Factors associated with the mental health of back-to-Wuhan university students based on quantile regression model during the COVID-19 period

BACKGROUND

The COVID-19 pandemic had brought the increased levels of depression and anxiety on people. Our study investigated the levels of mental health and influencing factors among back-to-Wuhan university students.

METHODS

A cross-sectional questionnaire survey was conducted from 31 August 2020, to 14 September 2020 by convenience sampling on the back-to-Wuhan university students, which included the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), the Insomnia Severity Index-7 (ISI-7), the revised Impact of Event Scale (IES-R) scales, and the basic demographic characteristics. Moreover, quantile regression analysis was used to identify the key factors related to the mental health variables of the back-to-Wuhan university students during the COVID-19 period.

RESULTS

The results from 1017 participants suggested that the prevalence rates of the anxiety, depression, insomnia, and distress were 44%, 47.5%, 37.7%, 57.7%, respectively. Quantile regression showed that mental health scores were negatively associated to age, years from graduation, being discriminated against owing to the experience in Wuhan, and the attitude on the future of COVID-19, while was positively related to the education level (P < 0.05). Especially, the education level was highly related with anxiety (25th = 1.64, 50th = 2.54).

CONCLUSION

The finding showed that the respondents who were near graduation, discriminated owing to the experience in Wuhan, and worried about the future trend of COVID-19 had a higher risk of negative psychologic status, especially in the bottom and median quantile, and might require more psycho-social interventions or support.

Intolerance of COVID-19-related uncertainty and depressive and anxiety symptoms during the pandemic: A longitudinal study in Argentina

The current COVID-19 pandemic is a novel, unprecedented situation that has created considerable uncertainty due in part to the unpredictability of the future situation. Intolerance of Uncertainty is the inability to withstand negative uncertain situations, and predisposes people to overestimate threats and to develop psychopathological symptoms. The aim of this study was to longitudinally analyze the relationship between intolerance of COVID-19-related uncertainty and anxiety and depression symptoms. A non-probabilistic online snowball sampling method was used. For the study, 1230 Argentine adults (216 men; 1005 women; 9 other genders; mean age = 41.62; SD = 13.81) were recruited to complete three open-access surveys at three different time points: (1) between May 6 and June 1, 2020, (2) between August 8 and 13, 2020, and (3) between April 17 and 23, 2021. The results suggest that anxiety and depressive symptoms increase over time, and that intolerance of uncertainty is a predictor of this variability even up to eleven months after the initial assessment. Gender- and age- related effects were also observed (women and young people reported more psychopathological symptoms). The findings suggest the importance of intolerance of uncertainty for mental health and the importance of this type of study for understanding the psychological impact of the pandemic.

Healthcare Workers' SARS-CoV-2 Omicron Variant Uncertainty-Related Stress, Resilience, and Coping Strategies during the First Week of the World Health Organization's Alert

BACKGROUND

As the SARS-CoV-2 Omicron variant emerged and spread globally at an alarming speed, healthcare workers' (HCWs) uncertainties, worries, resilience, and coping strategies warranted assessment. The COVID-19 pandemic had a severe psychological impact on HCWs, including the development of Post-Traumatic Stress symptoms. Specific subgroups of HCWs, such as front-line and female workers, were more prone to poor mental health outcomes and difficulties facing stress.

METHODS

The responses to an online questionnaire among HCWs in the Kingdom of Saudi Arabia (KSA) were collected from 1 December 2021 to 6 December 2021, aiming to assess their uncertainties, worries, resilience, and coping strategies regarding the Omicron variant. Three validated instruments were used to achieve the study's goals: the Brief Resilient Coping Scale (BRCS), the Standard Stress Scale (SSS), and the Intolerance of Uncertainty Scale (IUS)-Short Form.

RESULTS

The online survey was completed by 1285 HCWs. Females made up the majority of the participants (64%). A total of 1285 HCW's completed the online survey from all regions in KSA. Resilient coping scored by the BRCS was negatively and significantly correlated with stress as scored by the SSS (r = -0.313, p < 0.010). Moreover, intolerance of uncertainty scored by the IUS positively and significantly correlated with stress (r = 0.326, p < 0.010). Increased stress levels were linked to a considerable drop in resilient coping scores. Furthermore, being a Saudi HCW or a nurse was linked to a significant reduction in resilient coping ratings. Coping by following healthcare authorities' preventative instructions and using the WHO website as a source of information was linked to a considerable rise in resilient coping.

CONCLUSIONS

The negative association between resilient coping and stress was clearly shown, as well as how underlying intolerance of uncertainty is linked to higher stress among HCWs quickly following the development of a new infectious threat. The study provides early insights into developing and promoting coping strategies for emerging SARS-CoV-2 variants.

Viral Anxiety Mediates the Influence of Intolerance of Uncertainty on Adherence to Physical Distancing Among Healthcare Workers in COVID-19 Pandemic

INTRODUCTION

The aims of this study were to examine the mediation effect of viral anxiety of healthcare workers on the influence of their intolerance of uncertainty on the adherence to physical distancing during the COVID-19 pandemic.

METHODS

An online survey was conducted among 329 healthcare workers (female: 81.4%, nursing professionals: 59.0%, and shift workers: 22.3%) on November 29, 2021. Participants responded to questionnaires on adherence to physical distancing, health beliefs, and perceived social norms, and rating scales of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Patient Health Questionnaire-9 items (PHQ-9), and the Intolerance of Uncertainty-12 items (IUS-12) scale.

RESULTS

Adherence to physical distancing of healthcare workers was predicted by perceived benefits of physical distancing (β = 0.13, p = 0.01), personal injunctive norms (β = 0.32, p < 0.001), SAVE-6 score (β = 0.13, p = 0.02), and IUS-12 score (β = 0.10, p = 0.045) (adjusted R² = 0.21, F = 22.3, p < 0.001). Viral anxiety mediated the association between intolerance of uncertainty and adherence to physical distancing but not the influence of perceived benefits and personal injunctive norms on adherence to physical distancing.

CONCLUSION

We observed that viral anxiety of healthcare workers mediated the association between intolerance of uncertainty and adherence to physical distancing. During this pandemic, exploring adherence to physical distancing and its predicting factors will be helpful for the safety of healthcare workers and the patients for whom they care.

The impacts of coping style and perceived social support on the mental health of undergraduate students during the early phases of the COVID-19 pandemic in China: a multicenter survey

BACKGROUND

An increasing number of undergraduate students in China have been reported to have psychological problems. In response to the COVID-19 pandemic, a series of preventive and control measures were implemented, which undoubtedly worsened their psychological health. Coping style and social support were probably important factors that affected the psychological well-being of undergraduate students during the pandemic. This study aimed to explore the effects of coping style and perceived social support on the psychological well-being of college students and relevant risk factors.

METHODS

This cross-sectional study was performed in February and March of 2020 by distributing an online questionnaire among undergraduate students from seven geographical regions across China. The questionnaire included sociodemographic information; the 21-item Depression, Anxiety and Stress Scale (DASS-21); the Perceived Social Support Scale (PSSS); and the Simplified Coping Style Questionnaire (SCSQ). For the analyses, t-tests, one-way analysis of variance (ANOVA), the Kruskal-Wallis test and multiple linear regression were utilized. The level of significance was set at P < 0.05.

RESULTS

Among 3113 college students, the rates of anxiety, depression and stress symptoms were 13.3, 15.4 and 6.8%, respectively. Increased rates of current smoking and drinking (5.5 and 25.2%, respectively) among undergraduates were identified. The results indicated that the PSSS subscales and SCSQ subscales were significantly associated with DASS-21 scores (P < 0.001). Multiple linear regression analysis showed that active coping style and family support were protective factors while passive coping style could aggravate psychological problems among participants (P < 0.001).

CONCLUSIONS

A remarkable number of college students adopted passive coping strategies to cope with negative feelings, such as smoking and drinking, which were detrimental to their mental health. In contrast, active coping strategies helped improve their psychological well-being. Moreover, family support was particularly important for maintaining their mental health and ameliorating mental health challenges in this major health crisis. Consequently, suitable psychointervention, routine screening for risk behaviors, and provision of further social support are needed for undergraduate students in the COVID-19 pandemic or other emergency public health events.

Effects of COVID-19 lockdown on the mental health of dental students: A longitudinal study

OBJECTIVES

Many countries have enforced lockdowns on their populations due to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the effects of the lockdown on dental students.

METHODS

A longitudinal, repeated cross-sectional study was conducted to evaluate psychological problems experienced by dental students during the COVID-19 lockdown in Saudi Arabia. The dental students were selected from different universities using 2-stage cluster sampling. The validated Arabic version of the 21-item depression, anxiety, and stress scale questionnaire was distributed at the beginning and end of the lockdown. Mann-Whitney U and Kruskal-Wallis tests were used as appropriate. Chi-square test was used to compare the proportions between the sociodemographic data, and logistic regression analysis was used to identify variables associated with the students' responses.

RESULTS

A total of 1287 respondents participated in this study (695 first-survey respondents, 592 second-survey respondents). There were longitudinally significant differences in the students' mental health outcomes based on gender, university, class year, and survey time during the COVID-19 lockdown. The lockdown increased the likelihood of female, single, and junior students experiencing stress. The students who lived alone recorded a high chance of elevated levels of depression, anxiety, and stress, which showed a significant longitudinal reduction during the lockdown. Moreover, the lockdown increased the likelihood of mental health problems among the students staying in households of two persons or two-five persons.

CONCLUSIONS

This study indicates the importance of considering the detrimental mental health consequences on dental students in the event of future pandemics.

Measuring Online Teaching Service Quality in Higher Education in the COVID-19 Environment

The use of the Internet to develop new technologies has generated a considerable change in teaching and student learning in higher education. The pandemic caused by COVID-19 has forced universities to switch from face-to-face to online instruction. Furthermore, this transfer process was planned and executed quickly, with urgent redesigns of courses originally conceived for live teaching. The aim of this work is to measure the service quality of online teaching delivered during the COVID-19 period. The methodology was based on an importance-performance analysis using a structural equations model. The data were obtained from a sample of 467 students attending a university in southern Spain. The results reveal five priority attributes of online teaching that need to be improved in order to enhance the service quality of the virtual instruction provided to students. Universities need to redefine their online format by integrating methodological and technological decisions and involving collaboration between teachers, students and administration staff and services. The results do not apply to educational institutions that exclusively teach courses online, but to those institutions that had to rapidly adapt, and shift course material originally designed for face-to-face training.

Prevalence of and Factors Associated With Depressive Symptoms Among College Students in Wuhan, China During the Normalization Stage of COVID-19 Prevention and Control

Objectives: The 2019 coronavirus disease (COVID-19) epidemic has led to persistent negative psychological effects on the general public, especially on college students, who are highly susceptible to psychological difficulties, such as fear, anxiety, and depression. Little information is known about depressive symptoms among college students during the normalization stage of COVID-19 prevention and control in China. This study aimed to understand the prevalence of and factors associated with depressive symptoms after a long quarantine time and online learning at home among college students in Wuhan, China. Materials and Methods: A web-based survey was conducted from July to August 2020 during the Chinese summer holiday to collect data on sociodemographic variables, depressive symptoms, and their potential associated factors using an electronic questionnaire among college students in Wuhan, China. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Binary logistic regression was used to explore the factors associated with depressive symptoms. Results: A total of 9,383 college students were included in the analysis. The prevalence of depressive symptoms was 15.8% (1,486/9,383) among college students. The binary logistic regression showed that the 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 were independently associated with a higher risk of depressive symptoms. Academic stress and concern about the epidemic were the main reasons for their anxiety. Conclusions: Targeted psychological intervention measures are recommended for college students to improve their mental health during the normalization stage of COVID-19 prevention and control.