Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages

Apr 8, 2024Journal of affective disorders

How depression, anxiety, and insomnia symptoms are linked in Chinese college students during different pandemic stages

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Abstract

Among 381,152 Chinese college students surveyed, key symptoms included fatigue, restlessness, and uncontrollable worrying across three time periods during the COVID-19 pandemic.

The effective sample sizes were T1 - 164,101, T2 - 86,767, and T3 - 130,284, with a majority of female participants in each period.
Key central symptoms identified were fatigue, restlessness, uncontrollable worrying, excessive worry, and sleep insufficiency.
Fatigue, restlessness, and irritability consistently acted as bridge symptoms across all three periods.
Motor symptoms served as a bridge in T1 and T2 but weakened by T3.
Anxiety symptoms appeared to become more prominent over time, indicating a shift in mental health issues.

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BACKGROUND: As the stages of the COVID-19 pandemic evolved, the symptoms of depression, anxiety, and insomnia have increasingly manifested among Chinese college students. The aim of this study is to investigate the relationships between these symptoms through network analysis among Chinese college students during COVID-19.

METHOD: A three-wave cross-sectional survey was conducted at 22 colleges in Guangdong Province, involving 381,152 students during three specific time intervals: T1 (baseline, February 3 to 10, 2020), T2 (19 months after baseline, June 10 to 18, 2021), and T3 (37 months after baseline, March 15 to April 22, 2023). Depression (PHQ-9), anxiety (GAD-7), and insomnia (YSIS) were used separately. We analyzed two key network indices: "Expected influence" and "Bridge expected influence". Network stability was assessed through a case-dropping bootstrap program.

RESULT: The effective sample sizes for the three periods were as follows: T1 - 164,101 (103,645 females, 63.2 %), T2 - 86,767 (52,146 females, 60.1 %), and T3 - 130,284 (76,720 females, 58.9 %). Across these three periods, the key central symptoms were "Fatigue" (PHQ4), "Restlessness" (GAD5), "Uncontrollable worrying" (GAD2), "Worry too much" (GAD3) and "Sleep insufficiency" (YSIS6). Notably, "Fatigue" (PHQ4), "Restlessness" (GAD5) and "Irritability" (GAD6) consistently served as bridge symptoms. In the T1 and T2 period, "Motor" (PHQ8) acted as a bridge symptom but weakened in T3.

CONCLUSION: Throughout the three periods, the mental health issues among Chinese college students displayed characteristics of somatization within the depression-anxiety-insomnia comorbidity network. Over time, anxiety symptoms appeared to become more prominent. Consequently, this study highlights the importance of accurately identifying and promptly intervening in these core symptoms of mental health among college students, as these symptoms may evolve across different stages of a pandemic.

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Depression, anxiety, and insomnia symptoms among Chinese college students: A network analysis across pandemic stages

Abstract

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