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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
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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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.

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