Journal of affective disordersDec 1, 2020

Changes in College Students' Mental Health in China During the COVID-19 Pandemic Over Time

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 3, 2026

Abstract

Among 164,101 college students surveyed, 34.6% reported probable acute stress during the outbreak, which decreased to 16.4% during remission.

The prevalence of depressive symptoms increased from 21.6% at the onset of the outbreak to 26.3% during remission.
Anxiety symptoms rose from 11.4% to 14.7% between the two survey phases.
Senior students and those with community COVID-19 cases or related worries were at higher risk for mental health problems.
Factors such as less physical exercise, low perceived social support, and dysfunctional family dynamics were linked to negative psychological symptoms.
Some students experienced persistent or delayed mental health symptoms throughout the pandemic.

Simplified

BACKGROUND: Growing evidence supports a clear association between COVID-19 pandemic and mental health. However, little is known about the longitudinal course of psychopathology in young adults at different stages of the pandemic.

METHODS: This large-scale, longitudinal, population-based survey was conducted among college students in China. The rates of three mental health problems (acute stress, anxiety, and depressive symptoms), and their change patterns at two phases of the pandemic (early vs under-control) were measured. Predictors of changes in mental health symptoms were examined utilizing multivariate regression.

RESULTS: Among the 164,101 college students who participated in the first wave survey (T1=during onset of outbreak), 68,685 (41.9%) completed a follow-up survey (T2=during remission). In the follow-up survey, the prevalence of probable acute stress (T1: 34.6%; T2: 16.4%) decreased, while the rates of depressive (T1: 21.6%; T2: 26.3%) and anxiety symptoms (T1: 11.4%; T2: 14.7%) increased. Senior students, with suspected or conformed cases in their community and COVID-19 related worries (all AORs > 1.20, ps < 0.001) were found to have a higher risk of developing mental health problems in at least one wave. Less physical exercise, low perceived social support, and a dysfunctional family were found to negatively impact psychological symptoms.

CONCLUSIONS: Acute stress, anxiety, and depressive symptoms have been prevalent among college students during the COVID-19 epidemic, and showed a significant increase after the initial stage of the outbreak. Some college students, especially those with the risk factors noted above, exhibited persistent or delayed symptoms.

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Changes in College Students' Mental Health in China During the COVID-19 Pandemic Over Time

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