Prevalence and Risk Factors Associated With Self-reported Psychological Distress Among Children and Adolescents During the COVID-19 Pandemic in China | Adolescent Medicine | JN Learning | AMA Ed Hub [Skip to Content]
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Prevalence and Risk Factors Associated With Self-reported Psychological Distress Among Children and Adolescents During the COVID-19 Pandemic in China

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To identify the key insights or developments described in this article
1 Credit CME
JAMA Network Open
January 26, 2021
Original Investigation
Zuguo Qin, MPH1;
Lei Shi, MD2;
Yaqing Xue, MD2,3;
Huang Lin, MPH4;
Jinchan Zhang, MPH5;
Pengyan Liang, MPH1;
Zhiwei Lu, MPH1;
Mengxiong Wu, MPH1;
Yaguang Chen, MPH6;
Xiao Zheng, MD2,3;
Yi Qian, MD2;
Ping Ouyang, MD7;
Ruibin Zhang, PhD3,8;
Xuefeng Yi, MD1;
Chichen Zhang, MD2,7,9
Author Affiliations
  • 1Health Publicity and Education Center of Guangdong Province, Guangzhou, China
  • 2School of Health Services Management, Southern Medical University, Guangzhou, China
  • 3School of Public Health, Southern Medical University, Guangzhou, China
  • 4Department of Prevention and Health Care, Shantou Central Hospital/Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
  • 5Department of Medical Dispute, Maternal and Child Health Hospital, Heyuan, China
  • 6Health Education Center of Maoming City, Maoming, China
  • 7Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • 8Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
  • 9Institute of Health Management, Southern Medical University Guangzhou, Guangzhou, China
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Key Points

Question  What factors are associated with self-reported psychological distress among school-aged children and adolescents during the COVID-19 pandemic?

Findings  In this cross-sectional study including 1 199 320 children and adolescents, the prevalence of self-reported psychological distress was 10.5%. Students who never wore a face mask were at higher risk for psychological distress compared with students who wore a face mask frequently, as were students who spent less than 0.5 hours exercising compared with students who spent more than 1 hour in exercising.

Meaning  These findings suggest that the prevalence of self-reported psychological distress among school-aged children and adolescents during the COVID-19 pandemic was relatively high.

Abstract

Importance  Schools have been suspended nationwide in 188 countries, and classes have shifted to home-based distance learning models to control the spread of the coronavirus disease 2019 (COVID-19) pandemic. Additional information is needed to determine mental health status among school-aged children and adolescents during this public health crisis and the risk factors associated with psychological distress during the pandemic.

Objective  To assess self-reported psychological distress among school-aged children and adolescents associated with the COVID-19 pandemic.

Design, Setting, and Participants  This cross-sectional study using data from a survey on the mental health of school-aged children and adolescents in Guangdong province, China, conducted by using a stratified cluster random sampling method between March 8 to 30, 2020. To estimate outcomes associated with location of districts, only data from students with internet protocol addresses and current addresses in Guangdong were included. Data were analyzed from April 5 to July 20, 2020.

Exposure  Home-based distance learning during the COVID-19 pandemic.

Main Outcome and Measures  The main outcome was self-reported psychological distress, measured using the total score on the 12-item General Health Questionnaire of 3 or greater. Multivariate logistic regression was used to analyze risk factors associated with mental health status. Odds ratios (ORs) were used to analyze the associations of factors with psychological distress.

Results  Among 1 310 600 students who completed the survey, 1 199 320 students (mean [SD] age, 12.04 [3.01] years; 619 144 [51.6%] boys) were included in the final analysis. A total of 126 355 students (10.5%) self-reported psychological distress. Compared with students in primary school, high school students had increased risk of psychological distress (OR, 1.19 [95% CI, 1.15-1.23]). Compared with students who wore a face mask frequently, students who never wore a face mask had increased risk of psychological distress (OR, 2.59 [95% CI, 2.41-2.79]). Additionally, students who spent less than 0.5 hours exercising had increased odds of self-reported psychological distress compared with students who spent more than 1 hour exercising (OR, 1.64 [95% CI, 1.61-1.67]).

Conclusions and Relevance  These findings suggest that the prevalence of self-reported psychological distress among students during the COVID-19 pandemic was relatively high. Frequency of wearing a face mask and time spent exercising were factors associated with mental health. Therefore, it may be necessary for governments, schools, and families to pay attention to the mental health of school-aged children and adolescents during the COVID-19 pandemic and take corresponding countermeasures to reduce the impact of the COVID-19 pandemic on students’ mental health.

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Adolescent Medicine Global Health Pediatrics Psychiatry and Behavioral Health Public Health Coronavirus (COVID-19)
Article Information

Accepted for Publication: December 8, 2020.

Published: January 26, 2021. doi:10.1001/jamanetworkopen.2020.35487

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Qin Z et al. JAMA Network Open.

Corresponding Author: Chichen Zhang, MD, Southern Medical University, No. 1023-1063, Shatai S Rd, Baiyun District, Guangzhou 510515, China (zhangchichen@sina.com); Xuefeng Yi, MD, Health Publicity and Education Center of Guangdong Province, Guangzhou, Guangdong, China (yixuefeng123@21cn.com); Ruibin Zhang, PhD, Southern Medical University, Guangzhou, Guangdong, China (ruibinzhang@foxmail.com).

Author Contributions: Drs Yi and C. Zhang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Qin and Shi contributed equally as co–first authours. Drs R. Zhang, Yi, and C. Zhang contributed equally as co–corresponding authors.

Concept and design: Yi, C. Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Qin, Shi, Xue, Liang, Lu, Zheng, R. Zhang, Yi, C. Zhang.

Critical revision of the manuscript for important intellectual content: Qin, Shi, Lin, J. Zhang, Liang, Lu, Wu, Chen, Zheng, Qian, Ouyang, R. Zhang, Yi, C. Zhang.

Statistical analysis: All authors.

Obtained funding: C. Zhang.

Administrative, technical, or material support: Qin, Shi, Lin, J. Zhang, Liang, Lu, Wu, Chen, Zheng, Qian, Ouyang, R. Zhang, Yi, C. Zhang.

Supervision: Wu, Yi.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant No. 20ZD018 from the Key Projects for Research on Youth Development of Central Committee of the Communist Youth League, grant No. 2020KZDZX1046 from the Special Research Project of Prevention and Control during COVID-19 Epidemic in Universities of Guangdong, grant No. G620369695 from the Key Laboratory Development Project for Philosophy and Social Sciences in Guangdong, grant No. C2020062 from the Directive Project of Medical Scientific Research Foundation in Guangdong, and grant Nos. 31900806 and 71874104 from the National Nature Science Foundation of China.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Tencent. The latest release: unexplained pneumonia was found in Wuhan, and the expert team has arrived in Wuhan [in Chinese]. December 31, 2019. Accessed December 31, 2019. https://new.qq.com/omn/20191231/20191231A0KSDT00.html
2.
Wilder-Smith  A , Chiew  CJ , Lee  VJ .  Can we contain the COVID-19 outbreak with the same measures as for SARS?   Lancet Infect Dis. 2020;20(5):e102-e107. doi:10.1016/S1473-3099(20)30129-8 PubMedGoogle ScholarCrossref
3.
Rajkumar  RP .  COVID-19 and mental health: a review of the existing literature.   Asian J Psychiatr. 2020;52:102066. doi:10.1016/j.ajp.2020.102066 PubMedGoogle Scholar
4.
Lima  CKT , Carvalho  PMM , Lima  IAAS ,  et al.  The emotional impact of Coronavirus 2019-nCoV (new coronavirus disease).   Psychiatry Res. 2020;287:112915. doi:10.1016/j.psychres.2020.112915 PubMedGoogle Scholar
5.
Galea  S , Merchant  RM , Lurie  N .  The mental health consequences of COVID-19 and physical distancing: the need for prevention and early intervention.   JAMA Intern Med. 2020;180(6):817-818. doi:10.1001/jamainternmed.2020.1562 PubMedGoogle ScholarCrossref
6.
Farooq  A , Laato  S , Islam  AKMN .  Impact of online information on self-isolation intention during the COVID-19 pandemic: cross-sectional study.   J Med Internet Res. 2020;22(5):e19128. doi:10.2196/19128 PubMedGoogle Scholar
7.
Wang  C , Pan  R , Wan  X ,  et al.  Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China.   Int J Environ Res Public Health. 2020;17(5):1729. doi:10.3390/ijerph17051729PubMedGoogle ScholarCrossref
8.
Chen  IH , Chen  C-Y , Pakpour  AH , Griffiths  MD , Lin  C-Y .  Internet-related behaviors and psychological distress among schoolchildren during COVID-19 school suspension.   J Am Acad Child Adolesc Psychiatry. 2020;59(10):1099-1102.e1. doi:10.1016/j.jaac.2020.06.007PubMedGoogle ScholarCrossref
9.
WHO–UNICEF– Lancet Commissioners.  After COVID-19, a future for the world’s children?   Lancet. 2020;396(10247):298-300. doi:10.1016/S0140-6736(20)31481-1PubMedGoogle ScholarCrossref
10.
Wang  G , Zhang  Y , Zhao  J , Zhang  J , Jiang  F .  Mitigate the effects of home confinement on children during the COVID-19 outbreak.   Lancet. 2020;395(10228):945-947. doi:10.1016/S0140-6736(20)30547-X PubMedGoogle ScholarCrossref
11.
Oosterhoff  B , Palmer  CA , Wilson  J , Shook  N .  Adolescents’ motivations to engage in social distancing during the COVID-19 pandemic: associations with mental and social health.   J Adolesc Health. 2020;67(2):179-185. doi:10.1016/j.jadohealth.2020.05.004PubMedGoogle ScholarCrossref
12.
Voice of America. UNESCO: 290 Million Students Stay Home due to Coronavirus. Learning English. March 7, 2020. Accessed April 21, 2020. https://learningenglish.voanews.com/a/unesco-290-million-students-stay-home-due-to-coronavirus/5317148.html
13.
Van Lancker  W , Parolin  Z .  COVID-19, school closures, and child poverty: a social crisis in the making.   Lancet Public Health. 2020;5(5):e243-e244. doi:10.1016/S2468-2667(20)30084-0 PubMedGoogle ScholarCrossref
14.
Sprang  G , Silman  M .  Posttraumatic stress disorder in parents and youth after health-related disasters.   Disaster Med Public Health Prep. 2013;7(1):105-110. doi:10.1017/dmp.2013.22 PubMedGoogle ScholarCrossref
15.
Liang  Y , Wang  L , Yin  X .  The factor structure of the 12-item General Health Questionnaire (GHQ-12) in young Chinese civil servants.   Health Qual Life Outcomes. 2016;14(1):136. doi:10.1186/s12955-016-0539-y PubMedGoogle ScholarCrossref
16.
Li  WH , Chung  JO , Chui  MM , Chan  PS .  Factorial structure of the Chinese version of the 12-item General Health Questionnaire in adolescents.   J Clin Nurs. 2009;18(23):3253-3261. doi:10.1111/j.1365-2702.2009.02905.x PubMedGoogle ScholarCrossref
17.
Maharlouei  N , Alibeigi  H , Rezaianzadeh  A ,  et al.  The relationship between maternal mental health and communication skills in children in Shiraz, Iran.   Epidemiol Health. 2019;41:e2019035. doi:10.4178/epih.e2019035 PubMedGoogle Scholar
18.
Ong  LC , Norshireen  NA , Chandran  V .  Maternal mental health in families of children with spina bifida.   World J Pediatr. 2011;7(1):54-59. doi:10.1007/s12519-011-0246-z PubMedGoogle ScholarCrossref
19.
Jianmin  Z , Qichang  S , Yongli  F , Shumin  W , Wei  G , Xiajiang  Z .  Best practice of the cutting score of GHQ-12 detecting psychogical distress.   Chin J Epidemiol. 2010;31(3):354-356.PubMedGoogle Scholar
20.
Information Office People’s Government of Guangdong Province. The 26th Press Conference of the Guangdong Provincial Government Information Office on Epidemic Prevention and Control. News release. February 20, 2020. Accessed December 21, 2020. http://gdio.southcn.com/g/2020-02/20/content_190384009.htm
21.
Wang  J , Liu  K , Zheng  J , Liu  J , You  L .  Prevalence of mental health problems and associated risk factors among rural-to-urban migrant children in Guangzhou, China.   Int J Environ Res Public Health. 2017;14(11):1385. doi:10.3390/ijerph14111385 PubMedGoogle ScholarCrossref
22.
Qiu  J , Shen  B , Zhao  M , Wang  Z , Xie  B , Xu  Y .  A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations.   Gen Psychiatr. 2020;33(2):e100213. doi:10.1136/gpsych-2020-100213 PubMedGoogle Scholar
23.
Xie  X , Xue  Q , Zhou  Y ,  et al.  Mental health status among children in home confinement during the Coronavirus Disease 2019 outbreak in Hubei Province, China.   JAMA Pediatr. 2020;174(9):898-900. doi:10.1001/jamapediatrics.2020.1619 PubMedGoogle ScholarCrossref
24.
Campbell  AM .  An increasing risk of family violence during the COVID-19 pandemic: strengthening community collaborations to save lives.   Forensic Science International: Reports. 2020;2:100089. doi:10.1016/j.fsir.2020.100089Google Scholar
25.
Arias-de la Torre  J , Fernández-Villa  T , Molina  AJ ,  et al.  Psychological distress, family support and employment status in first-year university students in Spain.   Int J Environ Res Public Health. 2019;16(7):1209. doi:10.3390/ijerph16071209 PubMedGoogle ScholarCrossref
26.
Zhou  SJ , Zhang  LG , Wang  LL ,  et al.  Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19.   Eur Child Adolesc Psychiatry. 2020;29(6):749-758. doi:10.1007/s00787-020-01541-4 PubMedGoogle ScholarCrossref
27.
Huang  JP , Xia  W , Sun  CH , Zhang  HY , Wu  LJ .  Psychological distress and its correlates in Chinese adolescents.   Aust N Z J Psychiatry. 2009;43(7):674-680. doi:10.1080/00048670902970817 PubMedGoogle ScholarCrossref
28.
McLaughlin  KA , Costello  EJ , Leblanc  W , Sampson  NA , Kessler  RC .  Socioeconomic status and adolescent mental disorders.   Am J Public Health. 2012;102(9):1742-1750. doi:10.2105/AJPH.2011.300477 PubMedGoogle ScholarCrossref
29.
Rutter  M .  Poverty and child mental health: natural experiments and social causation.   JAMA. 2003;290(15):2063-2064. doi:10.1001/jama.290.15.2063 PubMedGoogle ScholarCrossref
30.
Javid  B , Weekes  MP , Matheson  NJ .  COVID-19: should the public wear face masks?   BMJ. 2020;369:m1442. doi:10.1136/bmj.m1442 PubMedGoogle ScholarCrossref
31.
Tam  VC , Tam  SY , Poon  WK , Law  HKW , Lee  SW .  A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong.   EClinicalMedicine. 2020;22:100356. doi:10.1016/j.eclinm.2020.100356PubMedGoogle Scholar
32.
Chekroud  SR , Gueorguieva  R , Zheutlin  AB ,  et al.  Association between physical exercise and mental health in 1·2 million individuals in the USA between 2011 and 2015: a cross-sectional study.   Lancet Psychiatry. 2018;5(9):739-746. doi:10.1016/S2215-0366(18)30227-XPubMedGoogle ScholarCrossref
33.
Peluso  MA , Guerra de Andrade  LH .  Physical activity and mental health: the association between exercise and mood.   Clinics (Sao Paulo). 2005;60(1):61-70. doi:10.1590/S1807-59322005000100012PubMedGoogle ScholarCrossref
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