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A longitudinal study on the mental health of general population during the COVID-19 epidemic in China
Open accessAbstract
In addition to being a public physical health emergency, Coronavirus disease 2019 (COVID-19) affected global mental health, as evidenced by panic-buying worldwide as cases soared. Little is known about changes in levels of psychological impact, stress, anxiety and depression during this pandemic. This longitudinal study surveyed the general population twice - during the initial outbreak, and the epidemic's peak four weeks later, surveying demographics, symptoms, knowledge, concerns, and precautionary measures against COVID-19. There were 1738 respondents from 190 Chinese cities (1210 first-survey respondents, 861 s-survey respondents; 333 respondents participated in both). Psychological impact and mental health status were assessed by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. This study found that there was a statistically significant longitudinal reduction in mean IES-R scores (from 32.98 to 30.76, p < 0.01) after 4 weeks. Nevertheless, the mean IES-R score of the first- and second-survey respondents were above the cut-off scores (>24) for PTSD symptoms, suggesting that the reduction in scores was not clinically significant. During the initial evaluation, moderate-to-severe stress, anxiety and depression were noted in 8.1%, 28.8% and 16.5%, respectively and there were no significant longitudinal changes in stress, anxiety and depression levels (p > 0.05). Protective factors included high level of confidence in doctors, perceived survival likelihood and low risk of contracting COVID-19, satisfaction with health information, personal precautionary measures. As countries around the world brace for an escalation in cases, Governments should focus on effective methods of disseminating unbiased COVID-19 knowledge, teaching correct containment methods, ensuring availability of essential services/commodities, and providing sufficient financial support.
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“In a sample of 1,173 undergraduate and postgraduate students from a university in the UK, over 50% of respondents surpassed clinical thresholds for anxiety and depression (21).”
From Mental health status and coping strategies during COVID-19 pandemic among university students in Central Serbia (2023) · cites this paper as [21]
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“recent international studies have reported increased symptoms of anxiety, depression, sleep disorders, and psychological distress during lockdown (4–10)”
From The Evolution of Psychological and Behavioral Consequences of Self-Isolation During Lockdown: A Longitudinal Study Across United Kingdom and Italy (2022) · cites this paper as [10]
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“Although a strength of the present study is that it addresses the absence of longitudinal studies examining the impact of COVID‐19 on adolescents (McGinty et al., 2020; Wang et al., 2020), there are several limitations that must be acknowledged.”
From Adolescents' longitudinal trajectories of mental health and loneliness: The impact of COVID‐19 school closures (2022) · cites this paper as Wang et al., 2020
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In the citing paper
“Recent research has shown that, in the general public, the COVID-19 pandemic is associated with greater levels of psychological distress and a range of psychopathological problems such as depression, anxiety, and post-traumatic stress symptoms (e.g., Gao et al., 2020; Qiu et al., 2020; Wang et al., 2020).”
From Why did all the toilet paper disappear? Distinguishing between panic buying and hoarding during COVID-19 (2021) · cites this paper as Wang et al., 2020
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“Consistent with the literature, our research suggested significant deleterious effects after the first week, followed by stabilization of the scores during the subsequent quarantine period, supporting the view that individuals may adapt to the negative consequences of social isolation and home confinement (10, 46, 93).”
From The Evolution of Psychological and Behavioral Consequences of Self-Isolation During Lockdown: A Longitudinal Study Across United Kingdom and Italy (2022) · cites this paper as [10]
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“Parallel literature from other countries indicates that there are higher levels of panic disorder, anxiety, and depression [1,43,44].”
From Relationships between psychopathology, psychological process variables, and sociodemographic variables and comparison of quarantined and non-quarantined groups of malaysian university students in the covid-19 pandemic (2021) · cites this paper as [44]
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“Factors relating to COVID-19 symptoms and disease exposure are associated with negative psychological outcomes including depression, anxiety and stress (Moghanibashi-Mansourieh, 2020; Wang et al., 2020).”
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“as are longitudinal studies including multiple time points during COVID‐19 (Wang et al., 2020).”
From Adolescents' longitudinal trajectories of mental health and loneliness: The impact of COVID‐19 school closures (2022) · cites this paper as Wang et al., 2020
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In the citing paper
“Wang et al. (2020) surveyed the general population in China, including adolescents, on two separate occasions (January 31 to February 2, 2020, ages 16–59 years; and February 28 to March 1, 2020, ages 12–59 years) and found levels of stress, anxiety, and depression remained stable, despite sharp increases in the number of COVID‐19 cases between the two surveys.”
From Adolescents' longitudinal trajectories of mental health and loneliness: The impact of COVID‐19 school closures (2022) · cites this paper as Wang et al. (2020)
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“Longitudinally, however, there were no significant changes in stress, anxiety and depression levels after one month in a follow-up study [44].”
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“Similarly, a study by Wang et al. (2020) found that the impact of digital infrastructure on international trade is stronger in countries with better institutional quality.”
From Digital Transformation in International Trade: Opportunities, Challenges, and Policy Implications (2025) · cites this paper as Wang et al. (2020)
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“Similarly, a study by Wang et al. (2020) found that institutional quality, digital infrastructure, and international trade are positively correlated in China.”
From Digital Transformation in International Trade: Opportunities, Challenges, and Policy Implications (2025) · cites this paper as Wang et al. (2020)
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“The authors suggest that better digital infrastructure enhances a country's trade competitiveness by reducing transaction costs and improving access to information.”
From Digital Transformation in International Trade: Opportunities, Challenges, and Policy Implications (2025) · cites this paper as Wang et al. (2020)
Experimental — accuracy not yet measuredIn the citing paper
“For example, recent studies found that insufficient information (González-Sanguino et al., 2020) or misinformation (‘fake news’) on COVID-19 (Wang et al., 2020) was associated with poorer mental health and well-being (Ko et al., 2020; Chao et al., 2020; Gao et al., 2020).”
From Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany (2020) · cites this paper as Wang et al., 2020
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Citations
Cites
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17051729 · Cited by 9,923 · cited 3×
“17 IES-R and DASS were previously used in research related to the COVID-19 epidemic. 8, 10, 18, 19”
Self-citationThe psychological impact of the COVID-19 epidemic on college students in China
Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112934 · Cited by 5,843 · cited 1×
“7 Recent mental health studies on COVID-19 were cross-sectional 8 , focusing on health professionals 9-11 or a particular age group 12 and lack of in-depth analysis to identify risk or protective factors for mental health.”
Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020) · General Psychiatry · doi:10.1136/gpsych-2020-100213 · Cited by 4,307 · cited 1×
“13 Currently, there is no known information about the longitudinal change of mental health status throughout the COVID-19 epidemic and factors that would influence psychological impact and mental health status with the implementation of public health measures of such unprecedented magnitude.”
Nervous system involvement after infection with COVID-19 and other coronaviruses
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“5 A recent study in China found that the vicarious traumatization scores of the general public were significantly higher than those of the front-line nurses.”
Self-citationKang, L., Ma, S., Chen, M., Yang, J., Wang, Y., Li, R., Yao, L., Bai, H., Cai, Z., Xiang Yang, B., et al. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.03.028 · Cited by 1,516
Rational use of face masks in the COVID-19 pandemic
Feng, S., Shen, C., Xia, N., Song, W., Fan, M., & Cowling, B. J. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30134-x · Cited by 1,443
Psychological impact of the COVID-19 pandemic on health care workers in Singapore
Tan, B. Y. Q., Chew, N. W. S., Lee, G. K. H., Jing, M., Goh, Y., Yeo, L. L. L., Zhang, K., Chin, H.-K., Ahmad, A., Khan, F. A., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m20-1083 · Cited by 1,279
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“6 As a result, governments and public health authorities urgently need guidance and actionable information on effective public health and psychological interventions that can safeguard the mental health of the general public.”
Liu, Y., Ho, R. C.-M., & Mak, A. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.08.003 · Cited by 948 · cited 1×
“22 These cytokines were commonly found to be increased in major depressive disorder 23, 24 and functional somatic syndromes 25 .”
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6 of the 31 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Europe on Lockdown From COVID-19. Jewish Journal, 2020. (Accessed March 22, 2020, at https://jewishjournal.com/commentary/opinion/312317/europe-on-lockdown-from-covid-19/).
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Subtypes of social withdrawal and mental health trajectories during COVID-19 pandemic
Xu, J., Sun, R.-X., Li, Y., Chen, X.-Y., Yiu, W., Zhou, N., Wang, Y.-N., Luo, S.-Y., Shen, J., & Liu, L. (2022) · Journal of Research in Personality · doi:10.1016/j.jrp.2022.104203 · Cited by 14
Spina, G., Roversi, M., Marchili, M. R., Raucci, U., Fini, F., Mirra, G., Testa, G., Guarnieri, B., Clemente, A., Diamanti, A., et al. (2022) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-022-01386-7 · Cited by 20
Cvetković, V. M., Nikolić, N., Ocal, A., Martinović, J., & Dragašević, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19020652 · Cited by 24
“[115] that age was not associated with disaster stress.”
BackgroundHan, J. M., & Song, H. (2021) · Psychology Research and Behavior Management · doi:10.2147/prbm.s326660 · Cited by 22
de Vargas, D., Pereira, C. F., Volpato, R., Lima, A. V. C., Ferreira, R. D. S., de Oliveira, S. R., & Aguilar, T. F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182212094 · Cited by 14
“In addition to physical symptoms, COVID-19 also caused several psychological outcomes, such as depression, anxiety, suicide, self-harm, and increased consumption of alcohol and other drugs [4,5].”
BackgroundThe Psychological Symptoms of College Student in China during the Lockdown of COVID-19 Epidemic
Li, Y., Qin, L., Shi, Y., & Han, J. (2021) · Healthcare · doi:10.3390/healthcare9040447 · Cited by 13
Radovanovic, J., Selakovic, V., Mihaljevic, O., Djordjevic, J., Čolović, S., Djordjevic, J. R., Janjic, V., Jovicic, M., Veselinovic, S., Vukomanovic, I. S., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1226836 · Cited by 10
“It used Depression Anxiety Stress Scales (DASS-21) and showed that two thirds of the students who participated (age ranging from 21 to 30) reported symptoms of depression, extremely severe forms of anxiety, and severe stress (25).”
MethodZaninotto, F., Bossi, F., Terry, P., Riccaboni, M., & Galli, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.826277 · Cited by 7
“China (10) and in the United States (93).”
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Metadata
- Authors
- Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., Choo, F. N., Tran, B., Ho, R., Sharma, V. K., & Ho, C.
- Affiliations
- Huaibei Normal University (CN)
- University Health Network (CA)
- National University of Singapore (SG)
- Johns Hopkins University (US)
- Corresponding author
- Ho, Roger
- ORCID
- Venue
- Brain, Behavior, and Immunity
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 87
- Pages
- 40-48
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC7153528
- OpenAlex
- W3016216556
- Cited by
- 2,571
- References
- 31
- Citations by year
- 2026: 32 · 2025: 103 · 2024: 176 · 2023: 347 · 2022: 611 · 2021: 845 · 2020: 455
- FWCI
- 225.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Brain Behavior and Immunity (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Funders
- National University of Singapore (R-722-000-004-731)
- Huaibei Normal University
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, mental health, psychological impact, anxiety, depression, stress, post-traumatic stress disorder, general population, protective factors, perceived infection risk, precautionary measures, China
- MeSH terms
- Betacoronavirus, Internet-Based Intervention, COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Child, China, Depression, Female, Humans, Longitudinal Studies, Male, Masks, Mental Health, Middle Aged, Pneumonia, Viral, Psychotherapy, Stress Disorders, Post-Traumatic, Stress, Psychological, Health Behavior, Coronavirus Infections, Young Adult, Epidemics, Pandemics, Hand Hygiene
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