Psychiatric symptoms, risk, and protective factors among university students in quarantine during the COVID-19 pandemic in China
Open accessPublished version of a preprint
Abstract
Background: The COVID-19 pandemic has made unprecedented impact on the psychological health of university students, a population vulnerable to distress and mental health disorders. This study investigated psychiatric symptoms (anxiety, depression, and traumatic stress) during state-enforced quarantine among university students in China ( N = 1912) through a cross-sectional survey during March and April 2020. Results: Psychiatric symptoms were alarmingly prevalent: 67.05% reported traumatic stress, 46.55% had depressive symptoms, and 34.73% reported anxiety symptoms. Further, 19.56% endorsed suicidal ideation. We explored risk and protective factors of psychological health, including demographic variables, two known protective factors for mental health (mindfulness, perceived social support), four COVID-specific factors (COVID-19 related efficacy, perceived COVID-19 threat, perceived COVID-19 societal stigma, COVID-19 prosocial behavior) and screen media usage. Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity. COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity. Screen media device usage was positively associated with depression. Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms. Conclusions: Findings suggest high need for psychological health promotion among university students during the COVID-19 pandemic and inform an ecological perspective on the detrimental role of stigma during an emerging infectious disease outbreak. Interventions targeting multi-level factors, such as promoting mindfulness and social support at individual and interpersonal levels while reducing public stigma about COVID-19, may be particularly promising. Attending to the needs of disadvantaged groups including those financially impacted by COVID-19 is needed.
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TL;DR
In a cross-sectional online survey of 1,912 Chinese university students during state-enforced COVID-19 quarantine, psychiatric symptoms were highly prevalent, with 67.05% reporting traumatic stress, 46.55% depressive symptoms, 34.73% anxiety symptoms, and 19.56% suicidal ideation. Mindfulness and social support were protective, while COVID-related financial stress, perceived COVID-19 threat, and perceived societal stigma were consistent risk factors, with threat and stigma interacting to predict all three symptom domains.
Key findings
- Clinically elevated symptoms were common: 67.05% for COVID-19-related traumatic stress (mild or higher), 46.55% for depression, and 34.73% for anxiety; 19.56% reported some suicidal ideation in the past 2 weeks. Moderate-or-higher elevations were 17.67% for traumatic stress, 15.58% for depression, and 9.62% for anxiety.
- Across anxiety, depression, and traumatic stress, mindfulness was associated with lower symptom severity, while COVID-19-related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity. Perceived social support was negatively associated with anxiety and depression.
- Perceived COVID-19 threat and perceived COVID-19 societal stigma showed significant main and interactive effects for all outcomes; their combination was associated with the highest symptom severity. Screen media usage was positively associated with depression; female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy was associated with lower anxiety.
Methods
- Cross-sectional online survey conducted March 20–April 10, 2020, during state-enforced quarantine; participants were recruited via websites and WeChat-based platforms, including advertisements distributed through academic advisors at 19 Chinese universities, with snowball sharing encouraged.
- Inclusion criteria: at least 18 years old, currently enrolled as an undergraduate or graduate student in a Chinese college/university, and fluent in Chinese; final sample was 1,912 students (mean age 20.28, SD = 2.10; 69.77% female; 91.84% undergraduate).
- Measures included GAD-7 for anxiety, PHQ-9 for depression, IES for COVID-19-related traumatic stress, MAAS for mindfulness, adapted MSPSS for perceived social support, and adapted COVID-19-specific measures of prosocial behavior, self-efficacy, societal stigma, and perceived threat. Analyses used bivariate tests, multiple regression models, interaction terms for threat × stigma, simple slopes, and model comparison.
Limitations
- The paper states that open internet recruitment may have attracted those highly impacted by COVID-19, potentially upwardly biasing symptom severity estimates; the sample was disproportionately female (69.77%), which may skew anxiety estimates and limit representativeness.
- The cross-sectional design precludes causal inference; the IES measured only intrusion and avoidance clusters of PTSD symptoms, missing other symptom clusters; and self-report measures may be subject to biases such as social desirability, with clinician-rated measures preferable for prevalence.
- The text also notes that the newly adapted COVID-19 prosocial behavior scale had not been validated, although exploratory and confirmatory factor analyses indicated a one-factor structure.
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Claims the paper makes
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- Findingown data
Symptom severity across psychiatric domains did not differ based on region of residence (Hubei vs non-Hubei).
“Symptom severity across psychiatric domains did not differ based on region of residence (Hubei, the hotspot of COVID-19 or non-Hubei).”
Quote in the paperNot a substantial claim - Findingown data
COVID-19 related financial stress was associated with higher symptom severity across anxiety, depression, and traumatic stress symptom domains.
“Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity.”
Quote in the paperSubstantial claim - Findingown data
The combination of perceived COVID-19 threat and perceived COVID-19 societal stigma was associated with highest symptom severity.
“COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity.”
Quote in the paperSubstantial claim - Findingown data
Perceived COVID-19 societal stigma was associated with higher symptom severity across anxiety, depression, and traumatic stress symptom domains.
“Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity.”
Quote in the paperSubstantial claim - Findingown data
Across anxiety, depression, and traumatic stress symptom domains, mindfulness was associated with lower symptom severity.
“Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity.”
Quote in the paperSubstantial claim
- Findingown data
Screen media device usage was positively associated with depression.
“Screen media device usage was positively associated with depression.”
Quote in the paperSubstantial claim - Findingown data
Female gender was associated with higher anxiety symptoms.
“Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms.”
- Also stated in: § Descriptive and bivariate statistics · plain
“Anxiety symptoms were higher for female participants (t [1017] = − 2.10, p = .036, mean [M] for male = 3.27, M for female = 3.74).”
Quote in the paperSubstantial claim - Also stated in: § Descriptive and bivariate statistics · plain
- Findingown data
COVID-19 self-efficacy was associated with lower anxiety symptoms.
“Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms.”
Quote in the paperSubstantial claim - Findingown data
17.67% of participants had moderate or higher clinical elevations of traumatic stress.
“Proportion with moderate or higher clinical elevations were 17.67% for traumatic stress, 15.58% for depression, and 9.62% for anxiety.”
Quote in the paperNot a substantial claim - Findingown data
46.55% of the sample had clinically elevated depressive symptoms.
“46.55% had depressive symptoms”
- Also stated in: § Descriptive and bivariate statistics · plain
“Anxiety symptoms were clinical elevated among 34.73% participants and 46.55% for depression.”
Quote in the paperSubstantial claim - Also stated in: § Descriptive and bivariate statistics · plain
- Findingown data
Depressive symptoms did not differ based on gender.
“Depressive symptoms and traumatic stress did not differ based on gender.”
Quote in the paperNot a substantial claim - Findingown data
Most clinical elevations were in the mild range.
“Most clinical elevations were in the mild range.”
Quote in the paperNot a substantial claim - Findingown data
Anxiety symptoms were higher for female participants than male participants (mean male = 3.27, mean female = 3.74).
“Anxiety symptoms were higher for female participants (t [1017] = − 2.10, p = .036, mean [M] for male = 3.27, M for female = 3.74).”
Quote in the paperNot a substantial claim - Findingown data
15.58% of participants had moderate or higher clinical elevations of depression.
“Proportion with moderate or higher clinical elevations were 17.67% for traumatic stress, 15.58% for depression, and 9.62% for anxiety.”
Quote in the paperNot a substantial claim - Findingown data
Age was weakly positively associated with anxiety symptoms.
“Age was weakly positively associated with anxiety.”
Quote in the paperNot a substantial claim - Findingown data
COVID-19 prosocial behavior was associated with higher anxiety symptoms.
“Female gender and COVID-19 prosocial behavior were associated with higher anxiety, while COVID-19 self-efficacy associated with lower anxiety symptoms.”
- Also stated in: § Predicting anxiety symptoms · plain
“Contrary to hypothesis, higher level of COVID-19 prosocial behavior positively associated with more anxiety symptoms.”
Quote in the paperSubstantial claim - Also stated in: § Predicting anxiety symptoms · plain
- Findingown data
Traumatic stress symptoms did not differ based on gender.
“Depressive symptoms and traumatic stress did not differ based on gender.”
Quote in the paperNot a substantial claim - Findingown data
Perceived COVID-19 threat was associated with higher symptom severity across anxiety, depression, and traumatic stress symptom domains.
“Across symptom domains, mindfulness was associated with lower symptom severity, while COVID-19 related financial stress, perceived COVID-19 societal stigma, and perceived COVID-19 threat were associated with higher symptom severity.”
Quote in the paperSubstantial claim - Findingown data
19.56% of participants reported some degree of suicidal ideation in the past 2 weeks (from rarely to often).
“19.56% endorsed suicidal ideation”
- Also stated in: § Descriptive and bivariate statistics · plain
“Approximately one in five (19.56%) reported some degree of suicidal ideation in the past 2 weeks (from rarely to often).”
Quote in the paperNot a substantial claim - Also stated in: § Descriptive and bivariate statistics · plain
- Findingown data
Perceived COVID-19 threat and perceived COVID-19 societal stigma showed main effects in predicting all mental health outcomes (anxiety, depression, and traumatic stress).
“COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity.”
Quote in the paperSubstantial claim - Findingown data
Among Chinese university students in state-enforced quarantine during March-April 2020, 67.05% reported COVID-19-related traumatic stress symptoms within the clinical range (mild or higher).
“67.05% reported traumatic stress”
- Also stated in: § Descriptive and bivariate statistics · plain
“The majority of participants (67.05%) reported COVID-19-related traumatic stress symptoms within the clinical range (i.e., mild or higher).”
Quote in the paperSubstantial claim - Also stated in: § Descriptive and bivariate statistics · plain
- Findingown data
34.73% of the sample had clinically elevated anxiety symptoms.
“34.73% reported anxiety symptoms”
- Also stated in: § Descriptive and bivariate statistics · plain
“Anxiety symptoms were clinical elevated among 34.73% participants and 46.55% for depression.”
Quote in the paperNot a substantial claim - Also stated in: § Descriptive and bivariate statistics · plain
- Findingown data
9.62% of participants had moderate or higher clinical elevations of anxiety.
“Proportion with moderate or higher clinical elevations were 17.67% for traumatic stress, 15.58% for depression, and 9.62% for anxiety.”
Quote in the paperNot a substantial claim - Findingown data
Perceived COVID-19 threat and perceived COVID-19 societal stigma showed interactive effects in predicting all mental health outcomes (anxiety, depression, and traumatic stress).
“COVID-19 threat and COVID-19 stigma showed main and interactive effects in predicting all mental health outcomes, with their combination associated with highest symptom severity.”
Quote in the paperSubstantial claim - Findingown data
COVID-19 related traumatic stress was significantly predicted by mindfulness (β = −0.178).
“mindfulness (β = − 0.178)”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, perceived COVID-19 societal stigma was positively associated with anxiety symptoms (β = 0.199).
“four COVID-19 specific factors including COVID-19 prosocial behavior (β = 0.049), COVID-19 self-efficacy (β = − 0.055), perceived COVID-19 threat (β = 0.160), and perceived COVID-19 societal stigma (β = 0.199).”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, perceived COVID-19 threat was positively associated with anxiety symptoms (β = 0.160).
“four COVID-19 specific factors including COVID-19 prosocial behavior (β = 0.049), COVID-19 self-efficacy (β = − 0.055), perceived COVID-19 threat (β = 0.160), and perceived COVID-19 societal stigma (β = 0.199).”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, perceived COVID-19 threat was positively associated with depressive symptoms (β = 0.109).
“Risk factors (i.e., positive correlates) for depressive symptoms included financial stress due to COVID-19 (β = 0.119), two COVID-specific risk factors (perceived COVID-19 threat: β = 0.109; perceived COVID-19 societal stigma: β = 0.238), and screen media device usage (β = 0.058).”
Quote in the paperSubstantial claim - Findingown data
Perceived COVID-19 threat remained a significant predictor of depression when perceived COVID-19 societal stigma was 1 SD below the mean (β = 0.053).
“or below the mean (β = 0.053 [0.005, 0.101], p = .029)”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, mindfulness was negatively associated with anxiety symptoms (β = −0.190).
“two known protective factors for anxiety symptoms including mindfulness (β = − 0.190) and social support (β = − 0.143)”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, gender was associated with anxiety symptoms (β = 0.045).
“The final model without interaction term (Model 2) included three demographic variables (age: β = 0.073, gender: β = 0.045, financial stress due to COVID-19: β = 0.124)”
Quote in the paperNot a substantial claim - Findingown data
In the final model without interaction, mindfulness was negatively associated with depressive symptoms (β = −0.249).
“Protective factors (i.e., negative correlates) for depressive symptoms included mindfulness (β = − 0.249) and perceived social support (β = − 0.153).”
Quote in the paperSubstantial claim - Findingown data
Mindfulness was negatively associated with all three forms of psychopathology.
“Both mindfulness and perceived social support emerged as protective factors, with mindfulness negatively associated with all three forms of psychopathology”
Quote in the paperSubstantial claim - Findingown data
COVID-19 related traumatic stress was significantly predicted by perceived COVID-19 societal stigma (β = 0.341).
“perceived COVID-19 societal stigma (β = 0.341)”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, screen media device usage was positively associated with depressive symptoms (β = 0.058).
“Risk factors (i.e., positive correlates) for depressive symptoms included financial stress due to COVID-19 (β = 0.119), two COVID-specific risk factors (perceived COVID-19 threat: β = 0.109; perceived COVID-19 societal stigma: β = 0.238), and screen media device usage (β = 0.058).”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, perceived COVID-19 societal stigma was positively associated with depressive symptoms (β = 0.238).
“Risk factors (i.e., positive correlates) for depressive symptoms included financial stress due to COVID-19 (β = 0.119), two COVID-specific risk factors (perceived COVID-19 threat: β = 0.109; perceived COVID-19 societal stigma: β = 0.238), and screen media device usage (β = 0.058).”
Quote in the paperSubstantial claim - Findingown data
Depression was notably higher when perceived COVID-19 societal stigma was increased.
“although depression was notably higher when perceived COVID-19 societal stigma was increased (Fig. 1b).”
Quote in the paperSubstantial claim - Findingown data
COVID-19 related traumatic stress was significantly predicted by perceived COVID-19 threat (β = 0.136).
“perceived COVID-19 threat (β = 0.136)”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, COVID-19 self-efficacy was negatively associated with anxiety symptoms (β = −0.055).
“four COVID-19 specific factors including COVID-19 prosocial behavior (β = 0.049), COVID-19 self-efficacy (β = − 0.055), perceived COVID-19 threat (β = 0.160), and perceived COVID-19 societal stigma (β = 0.199).”
Quote in the paperSubstantial claim - Findingown data
High levels of perceived COVID-19 societal stigma intensified the positive association between perceived COVID-19 threat and anxiety symptoms (β = 0.228 [0.173, 0.283], p < .001).
“Simple slope analysis found that high levels of perceived COVID-19 societal stigma intensified the positive association between perceived COVID-19 threat and anxiety symptoms (β = 0.228 [0.173, 0.283], p < .001; Fig. 1a).”
Quote in the paperSubstantial claim - Findingown data
The interaction between perceived COVID-19 threat and perceived COVID-19 societal stigma significantly predicted traumatic stress (β = 0.059).
“their interaction term significantly predicted traumatic stress, β = 0.059.”
Quote in the paperSubstantial claim - Findingown data
The full model explained 28.2% of variance in depression (adjusted R2 = .282).
“The full model explained 28.2% of variance in depression (i.e., adjusted R2 = .282).”
Quote in the paperNot a substantial claim - Findingown data
Socioeconomic status and family financial stress due to COVID-19 were correlated (r = −.43, p < .001).
“As socioeconomic status and family financial stress due to COVID-19 were correlated (r = − .43, p < .001) and measured related constructs, only family financial stress due to COVID-19 was used as a predictor in regression.”
Quote in the paperSubstantial claim - Findingown data
High levels of perceived COVID-19 societal stigma intensified the positive association between perceived COVID-19 threat and traumatic stress (β = 0.182).
“high levels of perceived COVID-19 societal stigma intensified the positive association between perceived COVID-19 threat and traumatic stress (β = 0.182 [0.128, 0.237], p < .001; Fig. 1c).”
Quote in the paperSubstantial claim - Findingcitation
The prevalence of clinically elevated depressive symptoms in our sample (46.6%) is roughly twice as high as meta-analytic estimates of clinical elevations among Chinese college students prior to the pandemic (23.8%).
“The prevalence of clinically elevated depressive symptoms in our sample (46.6%) is roughly twice as high as meta-analytic estimates of clinical elevations among Chinese college students prior to the pandemic (23.8%) [36].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [36] Lei XY, Xiao LM, Liu YN, Li YM. Prevalence of depression among Chinese university students: a neta-analysis. PLoS One. 2016;11:1–14. https://doi.org/10.1371/journal.pone.0153454. source
Not checked in the free run.
- Findingown data
At 1 SD below the mean of perceived COVID-19 societal stigma, it still heightened the positive association between perceived COVID-19 threat and traumatic stress, though to a less degree (β = 0.082).
“At 1 SD below the mean of perceived COVID-19 societal stigma, it still heightened the positive association between perceived COVID-19 threat and traumatic stress, though to a less degree (β = 0.082 [0.033, 0.131], p = .001).”
Quote in the paperNot a substantial claim - Findingown data
In the final model without interaction, financial stress due to COVID-19 was positively associated with depressive symptoms (β = 0.119).
“Risk factors (i.e., positive correlates) for depressive symptoms included financial stress due to COVID-19 (β = 0.119), two COVID-specific risk factors (perceived COVID-19 threat: β = 0.109; perceived COVID-19 societal stigma: β = 0.238), and screen media device usage (β = 0.058).”
Quote in the paperSubstantial claim - Findingown data
The model with the interaction accounted for 24.1% of the variance in traumatic stress, F = 122.2, p < .001.
“The model accounted for 24.1% of the variance in traumatic stress, F = 122.2, p < .001.”
Quote in the paperSubstantial claim - Findingown data
Perceived COVID-19 threat and perceived COVID-19 societal stigma had a significant interaction predicting depressive symptoms, after accounting for other significant variables.
“Perceived COVID-19 threat and perceived COVID-19 societal stigma had significant interaction (Model 3, β = 0.076, p < .001), after accounting for all other significant variables identified in Model 2.”
Quote in the paperSubstantial claim - Findingown data
Perceived social support was negatively associated with anxiety and depression.
“and perceived social support negatively associated with anxiety and depression.”
Quote in the paperSubstantial claim - Findingown data
As hypothesized, perceived COVID-19 threat predicted elevated psychiatric symptoms.
“As hypothesized, perceived COVID-19 threat, namely the felt sense of threat to one’s health and life by COVID-19, predicted elevated psychiatric symptoms”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, perceived social support was negatively associated with depressive symptoms (β = −0.153).
“Protective factors (i.e., negative correlates) for depressive symptoms included mindfulness (β = − 0.249) and perceived social support (β = − 0.153).”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, social support was negatively associated with anxiety symptoms (β = −0.143).
“two known protective factors for anxiety symptoms including mindfulness (β = − 0.190) and social support (β = − 0.143)”
Quote in the paperSubstantial claim - Findingown data
Perceived COVID-19 threat and COVID-19 societal stigma showed synergistic interaction, such that presence of both was associated with additive effects when predicting all three symptom domains.
“Perceived COVID-19 threat and COVID-19 societal stigma showed synergistic interaction, such that the presence of both were associated with additive effects when predicting all three symptom domains”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, financial stress due to COVID-19 was positively associated with anxiety symptoms (β = 0.124).
“The final model without interaction term (Model 2) included three demographic variables (age: β = 0.073, gender: β = 0.045, financial stress due to COVID-19: β = 0.124)”
Quote in the paperNot a substantial claim - Findingown data
COVID-19 related traumatic stress was significantly predicted by financial stress due to COVID-19 (β = 0.100).
“COVID-19 related traumatic stress was significantly predicted by financial stress due to COVID-19 (β = 0.100)”
Quote in the paperSubstantial claim - Findingown data
In the context of COVID-19, perceived societal stigma adversely affects the mental health of the general public (i.e., university students, not a group particularly vulnerable for infection or death).
“However, our study found that in the context of COVID-19, perceived societal stigma adversely affects the mental health of the general public (i.e., university students, not a group particularly vulnerable for infection or death).”
Quote in the paperSubstantial claim- Rests on an assumption: Stigma research has focused on victimized groups.
- Findingown data
The interaction term of perceived COVID-19 threat and perceived COVID-19 societal stigma was significant in predicting anxiety symptoms (β = 0.070, p < .001).
“Accounting for all significant variables identified in Model 2, the interaction term of perceived COVID-19 threat X perceived COVID-19 societal stigma was significant in predicting anxiety symptoms (Table 3; Model 3), β = 0.070, p < .001.”
Quote in the paperSubstantial claim - Findingown data
Screen media usage was weakly associated with depressive symptoms.
“Screen media usage was weakly associated with depressive symptoms.”
Quote in the paperNot a substantial claim - Findingown data
The model predicting traumatic stress from these variables had adjusted R2 = 0.238, F = 150.0, p < .001.
“Model’s adjusted R2 = 0.238, F = 150.0, p < .001 (Table 5; Model 2).”
Quote in the paperSubstantial claim - Findingown data
At 1 SD below the mean of perceived COVID-19 societal stigma, it still heightened the detrimental effect of perceived COVID-19 threat on anxiety symptoms (β = 0.109 [0.060, 0.159], p < .001).
“At 1 SD below the mean of perceived COVID-19 societal stigma, it still heightened the detrimental effect of perceived COVID-19 threat on anxiety symptoms, β = 0.109 [0.060, 0.159], p < .001.”
Quote in the paperSubstantial claim - Findingown data
Across anxiety, depression, and traumatic stress, COVID-related financial stress, perceived threat, and perceived societal stigma emerged as consistent positive correlates of psychopathology.
“Across symptoms domains (anxiety, depression, traumatic stress), COVID-related financial stress, perceived threat, and perceived societal stigma emerged as consistent positive correlates of psychopathology.”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, age was positively associated with anxiety symptoms (β = 0.073).
“The final model without interaction term (Model 2) included three demographic variables (age: β = 0.073, gender: β = 0.045, financial stress due to COVID-19: β = 0.124)”
Quote in the paperNot a substantial claim - Findingown data
Perceived COVID-19 threat remained a significant predictor of depression when perceived COVID-19 societal stigma was 1 SD above the mean (β = 0.182).
“perceived COVID-19 threat remained a significant predictor of depression when perceived COVID-19 societal stigma was 1 SD above (β = 0.182 [0.129, 0.235], p < .001)”
Quote in the paperSubstantial claim - Findingown data
The positive association between perceived COVID-19 threat and depressive symptoms was amplified at higher levels of perceived COVID-19 societal stigma.
“As predicted, the positive association between perceived COVID-19 threat with depressive symptoms was amplified in the presence of higher levels of perceived COVID-19 societal stigma.”
Quote in the paperSubstantial claim - Findingown data
In the final model without interaction, COVID-19 prosocial behavior was positively associated with anxiety symptoms (β = 0.049).
“four COVID-19 specific factors including COVID-19 prosocial behavior (β = 0.049), COVID-19 self-efficacy (β = − 0.055), perceived COVID-19 threat (β = 0.160), and perceived COVID-19 societal stigma (β = 0.199).”
Quote in the paperSubstantial claim - Findingown data
Participants self-reported an average of 6 h of daily screen media time outside of school and work purposes in the past 2 weeks.
“In our sample, participants’ self-reported an average of 6 h of daily screen media time outside of school and work purposes in the past 2 weeks.”
Quote in the paperNot a substantial claim - Premisecitation
The early phase of an emerging outbreak tends to be characterized by intense disease-related stigma and fear due to its evolving nature and scientific uncertainties.
“Stigma was also examined as a potential factor related to mental health problems, as the early phase of an emerging outbreak tends to be characterized by intense disease-related stigma and fear due to its evolving nature and scientific uncertainties [20, 48].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [20] Des Jarlais DC, Galea S, Tracy M, Tross S, Vlahov D. Stigmatization of newly emerging infectious diseases: AIDS and SARS. Am. J. Public Health. 2006;96:561–7. https://doi.org/10.2105/AJPH.2004.054742. source
Not checked in the free run.
- cites [48] Person B, Sy F, Holton K, Govert B, Liang A, the NCID/SARS Community Outreach Team. Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10:358–63. source
Not checked in the free run.
- Interpretationown data
Prevalence rates indicate continued mental health needs within this population during the early phase of the pandemic.
“Prevalence rates indicate continued mental health needs within this population during the early phase of the pandemic.”
Quote in the paperSubstantial claim - Interpretationown data
Findings inform an ecological perspective on the detrimental role of stigma during an emerging infectious disease outbreak.
“Findings suggest high need for psychological health promotion among university students during the COVID-19 pandemic and inform an ecological perspective on the detrimental role of stigma during an emerging infectious disease outbreak.”
Quote in the paperSubstantial claim- Rests on an assumption: The observed associations between predictors and psychiatric symptoms reflect causal risk or protective effects rather than reverse causation or unmeasured confounding.
- Interpretationcitation
The prevalence of anxiety, depression, and traumatic stress among university students in this study is similar yet slightly higher than findings reported in two other recent studies concerning the initial phase of the outbreak.
“The prevalence on anxiety, depression, and traumatic stress among university students uncovered from this study is similar yet slightly higher than findings reported in two other recent studies concerning the initial phase of the outbreak [14, 57].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [14] Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, Zheng J. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934. https://doi.org/10.1016/j.psychres.2020.112934. source
Not checked in the free run.
- cites [57] Tang W, Hu T, Hu B, Jin C, Wang G, Xie C, Chen S, Xu J. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord. 2020;274:1–7. https://doi.org/10.1016/j.jad.2020.05.009. source
Not checked in the free run.
- Premisecitation
Research on infectious disease stigma has focused on those infected or most vulnerable to infection.
“Research on infectious disease stigma has focused on those infected or most vulnerable to infection (e.g., anticipated HIV stigma among gay and bisexual men) [55].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [55] Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16:18734. https://doi.org/10.7448/ias.16.3.18734. source
Not checked in the free run.
- Premisecitation
Perceived social support is an established protective factor for well-being.
“Perceived social support is another established protective factor for well-being [8, 28], and it may be particularly crucial during the COVID-19 pandemic due to increased social isolation.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Bovier PA, Chamot E, Perneger TV. Perceived stress, internal resources, and social support as determinants of mental health among young adults. Qual Life Res. 2004;13:161–70. https://doi.org/10.1023/B:QURE.0000015288.43768.e4. source
Not checked in the free run.
- cites [28] Hefner J, Eisenberg D. Social support and mental health among college students. Am J Orthop. 2009;79:491–9. https://doi.org/10.1037/a0016918. source
Not checked in the free run.
- Interpretationcitation
Results of this study are largely consistent with prior studies in China and elsewhere highlighting adverse psychological consequences in the general population of both quarantine and disease outbreak.
“Results of this large-scale, cross-sectional study are largely consistent with prior studies in China and elsewhere highlighting the adverse psychological consequences in the general population of both quarantine and disease outbreak [10, 14, 57].”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [10] Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–20. https://doi.org/10.1016/S0140-6736(20)30460-8. source
Not checked in the free run.
- cites [14] Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, Zheng J. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934. https://doi.org/10.1016/j.psychres.2020.112934. source
Not checked in the free run.
- cites [57] Tang W, Hu T, Hu B, Jin C, Wang G, Xie C, Chen S, Xu J. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord. 2020;274:1–7. https://doi.org/10.1016/j.jad.2020.05.009. source
Not checked in the free run.
- Premisecitation
Mindfulness has been consistently identified as a protective factor for psychological distress.
“Mindfulness, defined as “paying attention in a particular way, on purpose, in the present moment, and nonjudgmentally” ([31], p. 4), has been consistently identified as a protective factor for psychological distress [11, 25, 32].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [11] Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84:822–48. source
Not checked in the free run.
- cites [25] Goldberg SB, Tucker RP, Greene PA, Davidson RJ, Wampold BE, Kearney DJ, Simpson TL. Mindfulness-based interventions for psychiatric disorders: a systematic review and meta-analysis. Clin Psychol Rev. 2018;59:52–60. https://doi.org/10.1016/j.cpr.2017.10.011. source
Not checked in the free run.
- cites [32] Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. 2011;31:1041–56. https://doi.org/10.1016/j.cpr.2011.04.006. source
Not checked in the free run.
- Study design and conductown data
Cronbach's α for the PHQ-9 was 0.93.
“Cronbach’s α was 0.93.”
Quote in the paperNot a substantial claim - Interpretationown data
The significant interaction between perceived COVID-19 societal stigma and personal sense of COVID-19 threat informs a theory-driven, ecological perspective in understanding the role of stigma on psychiatric symptoms during an emerging pandemic.
“Further, the significant interaction between perceived COVID-19 societal stigma and personal sense of COVID-19 threat informs a theory-driven, ecological perspective in understanding the role of stigma on psychiatric symptoms during an emerging pandemic.”
Quote in the paperSubstantial claim - Study design and conductreasoning
Given the study's cross-sectional method, causal directions of the observed relationships cannot be ascertained.
“Second, given the study’s cross-sectional method, causal directions of the observed relationships cannot be ascertained.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The open recruitment method via the internet may upwardly bias estimates of psychiatric symptom severity because those highly impacted by COVID-19 may be particularly interested in participation.
“In particular, those highly impacted by COVID-19 may be particularly interested in participation, which could upwardly bias estimates of psychiatric symptom severity.”
Quote in the paperNot a substantial claim - Premisecitation
Efforts to address mental health crisis during pandemic in China and other global regions have often largely focused on psychiatric patients and frontline health workers.
“While there have been efforts to address the mental health crisis during the pandemic in China and other global regions, they have often largely focused on psychiatric patients and frontline health workers [64].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [64] Xiang Y, Jin Y, Cheung T. Joint international collaboration to combat mental health challenges during the coronavirus disease 2019 pandemic. JAMA Psychiatry. 2020;77:989–90. https://doi.org/10.1001/jamapsychiatry.2020.1057. source
Not checked in the free run.
- Study design and conductown data
The sample was disproportionately female participants (69.77%).
“our sample was disproportionately female participants (69.77%).”
Quote in the paperSubstantial claim - Interpretationown data
Findings inform an ecological-driven understanding regarding the detrimental role of public stigma on psychological health in the general population during an emerging infectious disease outbreak.
“In addition, findings inform an ecological-driven understanding regarding the detrimental role of public stigma on psychological health in the general population during an emerging infectious disease outbreak.”
Quote in the paperSubstantial claim- Rests on an assumption: Stigma research has focused on victimized groups.
- Study design and conductcitation
The Impact of Events Scale (IES) only measured two clusters of PTSD symptoms (intrusion and avoidance), missing negative alterations in cognition or mood and hyperarousal symptoms.
“Third, the Impact of Events Scale (IES) [30] only measured two clusters of PTSD symptoms (intrusion and avoidance), missing negative alternations in cognition or mood and hyperarousal symptoms.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209–18. https://doi.org/10.1097/00006842-197905000-00004. source
Not checked in the free run.
- Interpretationreasoning
Findings from this study highlight the relevance of stigma in the mental health of the general public during an infectious disease outbreak.
“Findings from this study highlight the relevance of stigma in the mental health of the general public during an infectious disease outbreak.”
Quote in the paperNot a substantial claim- Rests on an assumption: Stigma research has focused on victimized groups.
- May combine two claims. 9
- Classified as probably not a substantial claim. 31
May combine two claims.
Findingown dataModel 3 was superior to Model 2 for traumatic stress, F = 8.70, p = .003, and accounted for 3% additional variance.
“Model 3 was superior to model 2, F = 8.70, p = .003, and accounted for 3% additional variance.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataBeing older and female were identified as risk factors of anxiety symptoms.
“In addition to financial stress, being older and female were also identified as risk factors of anxiety symptoms.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataCOVID-19 prosocial behavior was associated with heightened anxiety.
“For instance, COVID-19 prosocial behavior was associated with heightened anxiety”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataConducted in March and April 2020 during massive, state-enforced quarantine, the current study found high rates of psychiatric symptoms in a sample of internet-recruited university students in China.
“Conducted in March and April 2020 during massive, state-enforced quarantine, the current study found high rates of psychiatric symptoms in a sample of internet-recruited university students in China.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationAltruistic and prosocial social behavior appears to promote well-being for the helpers.
“Altruistic and prosocial social behavior appears to promote well-being for the helpers [18, 39].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [18] Curry OS, Rowland LA, Van Lissa CJ, Zlotowitz S, McAlaney J, Whitehouse H. Happy to help? A systematic review and meta-analysis of the effects of performing acts of kindness on the well-being of the actor. J Exp Soc Psychol. 2018;76:320–9. https://doi.org/10.1016/j.jesp.2018.02.014. source
Not checked in the free run.
- cites [39] Martela F, Ryan RM. Prosocial behavior increases well-being and vitality even without contact with the beneficiary: causal and behavioral evidence. Motiv Emot. 2016;40:351–7. https://doi.org/10.1007/s11031-016-9552-z. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the perceived COVID-19 societal stigma scale was 0.91.
“Cronbach’s α was 0.91.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationBelief in one's capacity to prevent COVID-19 and take necessary steps for treatment may facilitate an increased sense of control in an evolving outbreak.
“COVID-19 self-efficacy was explored as a predictor of mental health, as belief in one’s capacity to prevent COVID-19 and take necessary steps for treatment may facilitate an increased sense of control in an evolving outbreak [48].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Person B, Sy F, Holton K, Govert B, Liang A, the NCID/SARS Community Outreach Team. Fear and stigma: the epidemic within the SARS outbreak. Emerg Infect Dis. 2004;10:358–63. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe GAD-7 has demonstrated good reliability and validity in outpatient settings in China.
“The scale has demonstrated good reliability and validity in outpatient settings in China [65].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [65] Zeng Q-Z, He Y-L, Liu H, Miao J-M, Chen J-X, Xu H-N, Wang J-Y. Reliability and validity of Chinese version of the generalized anxiety disorder 7-item (GAD-7) scale in screening anxiety disorders in outpatients from traditional Chinese internal department. Chinese Ment Heal J. 2013;27:163–8.
Not checked in the free run.
Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Study design and conductnone givenCronbach's α for the MSPSS was 0.93.
“Cronbach’s α was 0.93.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the GAD-7 was 0.96.
“Cronbach’s α was 0.96.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the COVID-19 self-efficacy scale was 0.90.
“Cronbach’s α was 0.90.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA recent study found 90% of respondents in China exhibited discriminatory attitudes toward people and regions associated with the COVID-19 outbreak.
“A recent study found 90% of respondents in China exhibited discriminatory attitudes toward people and regions associated with the COVID-19 outbreak [27].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] He J, He L, Zhou W, Nie X, He M. Discrimination and social exclusion in the outbreak of COVID-19. Int J Environ Res Public Health. 2020;17:2933. https://doi.org/10.3390/ijerph17082933. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study was approved by the Institutional Review Board at Beijing Normal University.
“The study was approved by the Institutional Review Board at Beijing Normal University.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenData were collected via an anonymous online survey.
“Data were collected via an anonymous online survey.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationThe ecological model (person X context) informed the examination of potential interaction between perceived COVID-19 threat and perceived COVID-19 societal stigma.
“This was informed by the ecological model (person X context) [9, 17].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [9] Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol. 1977;32:513–31. https://doi.org/10.1037/0003-066X.32.7.513. source
Not checked in the free run.
- cites [17] Cook JE, Purdie-Vaughns V, Meyer IH, Busch JTA. Intervening within and across levels: a multilevel approach to stigma and public health. Soc Sci Med. 2014;103:101–9. https://doi.org/10.1016/j.socscimed.2013.09.023. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the MAAS was 0.94.
“Cronbach’s α was 0.94.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataAll regression analyses complied with assumptions regarding variable distribution and there was no evidence for collinearity (VIF values ranged from 1.02 to 1.50).
“All regression analyses complied with assumptions regarding variable distribution and there was no evidence for collinearity (VIF values ranged from 1.02 to 1.50).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Study design and conductown dataCronbach's α for the COVID-19 prosocial behavior scale was 0.93.
“Cronbach’s α was 0.93.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationPerceived SARS threat predicted emotional exhaustion among frontline nurses during the SARS outbreak.
“Consistent with prior work showing perceived SARS threat predicted emotional exhaustion among frontline nurses during the SARS outbreak [23], we examined perceived COVID-19 threat (i.e., perception of one’s likelihood of contracting COVID-19) as a risk factor.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Fiksenbaum L, Marjanovic Z, Greenglass ER, Coffey S. Emotional exhaustion and state anger in nurses who worked during the SARS outbreak: the role of perceived threat and organizational support. Can J Community Ment Heal. 2006;25:89–103. https://doi.org/10.7870/cjcmh-2006-0015. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe newly adapted COVID-19 prosocial behavior scale has not been validated.
“This newly adapted scale has not been validated.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationown dataFindings suggest high need for psychological health promotion among university students during the COVID-19 pandemic.
“Findings suggest high need for psychological health promotion among university students during the COVID-19 pandemic and inform an ecological perspective on the detrimental role of stigma during an emerging infectious disease outbreak.”
Quote in the paperSubstantial claim- Rests on an assumption: The sample of 1912 Chinese university students recruited online is representative of Chinese university students during state-enforced quarantine.
May combine two claims.
Study design and conductown dataExploratory factor analysis and confirmatory factor analysis indicated a one-factor structure for the COVID-19 prosocial behavior scale, with all items having sufficient loadings (≥ .40, all items had a standardized loading > .70).
“Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) indicated a one-factor structure, with all items having sufficient loadings (≥ .40, all items had a standardized loading > .70).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the perceived COVID-19 threat scale was 0.72.
“Cronbach’s α was 0.72.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataCronbach's α for the IES was 0.95.
“Cronbach’s α was 0.95.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMost mental health systems in LMIC context, including in China, are often overburdened by high demand yet inadequately funded.
“Most mental health systems in LMIC context, including in China, are often overburdened by high demand yet inadequately funded [63].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [63] World Health Organization. Mental health atlas 2017: World Health Organization; 2017. https://apps.who.int/iris/bitstream/handle/10665/272735/9789241514019-eng.pdf?ua=1.
Not checked in the free run.
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataFindings highlight the high need for psychological health promotion in this population.
“Findings highlight the high need for psychological health promotion in this population.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationWomen report greater anxiety and are more likely to develop anxiety disorders than men.
“which is consistent with existing evidence that women report greater anxiety and more likely to develop anxiety disorders than men [40].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [40] McLean CP, Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev. 2009;29:496–505. https://doi.org/10.1016/j.cpr.2009.05.003. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIndividuals from lower socioeconomic background have been disproportionately burdened across the globe during COVID-19.
“As the economic consequences of COVID-19 have continued to unfold, it has become clear that individuals from lower socioeconomic background have been disproportionately burdened across the globe [1, 12].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [1] Ahmed F, Ahmed N, Pissarides C, Stiglitz J. Why inequality could spread COVID-19. Lancet Public Health. 2020;5:e240. https://doi.org/10.1016/S2468-2667(20)30085-2. source
Not checked in the free run.
- cites [12] Buheji M, da Costa Cunha K, Beka G, Mavrić B, Leandro do Carmo de Souza Y, Souza da Costa Silva S, Hanafi M, Chetia Yein T. The extent of COVID-19 pandemic socio-economic impact on global poverty: a global integrative multidisciplinary review. Am J Econ. 2020;2020:213–24. https://doi.org/10.5923/j.economics.20201004.02. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDecreased rumination may be one of the key mechanisms underlying the efficacy of mindfulness-based interventions.
“This is supported by evidence suggesting decreased rumination may be one of the key mechanisms underlying the efficacy of mindfulness-based interventions [26].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26] Gu J, Strauss C, Bond R, Cavanagh K. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12. https://doi.org/10.1016/j.cpr.2015.01.006. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningThe higher proportion of women could have skewed the estimates in anxiety, given the higher prevalence of anxiety in female students.
“The higher proportion of women could have skewed the estimates in anxiety, given the higher prevalence of anxiety in female students.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationPast economic recessions have witnessed increased rates of common mental disorders and suicidal behavior in other global regions.
“past economic recessions have witnessed increased rates of common mental disorders and suicidal behavior in other global regions [44, 50].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [44] Nordt C, Warnke I, Seifritz E, Kawohl W. Modelling suicide and unemployment: a longitudinal analysis covering 63 countries, 2000-11. Lancet Psychiatry. 2015;2:239–45. https://doi.org/10.1016/S2215-0366(14)00118-7. source
Not checked in the free run.
- cites [50] Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. Increase in state suicide rates in the USA during economic recession. Lancet. 2012;380:1813–4. https://doi.org/10.1016/S0140-6736(12)61910-2. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductnone givenWe collected a large, geographically diverse sample during the early phase of the COVID-19 pandemic and included a variety of psychiatric symptoms.
“We collected a large, geographically diverse sample during the early phase of the COVID-19 pandemic and included a variety of psychiatric symptoms.”
Quote in the paperNot a substantial claimMay combine two claims.
InterpretationreasoningThe gender makeup and recruitment method may lead to findings not being representative of the larger Chinese university student population.
“Additionally, the gender makeup and recruitment method may lead to findings not being representative of the larger Chinese university student population.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataThis research can clarify the psychological consequences, risk, and protective factors of acute stress more generally.
“In addition to informing current and future pandemic responses, this research can also clarify the psychological consequences, risk, and protective factors of acute stress more generally.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationExcessive screen time has been linked to a variety of health concerns including obesity, sleep disturbance, and mental health issues.
“Excessive screen time has been linked to a variety of health concerns including obesity, sleep disturbance, and mental health issues [7, 22].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [7] Boone JE, Gordon-Larsen P, Adair LS, Popkin BM. Screen time and physical activity during adolescence: longitudinal effects on obesity in young adulthood. Int J Behav Nutr Phys Act. 2007;4:61–71. https://doi.org/10.1186/1479-Received. source
Not checked in the free run.
- cites [22] Feng Q, Le Zhang Q, Du Y, Ye YL, He QQ. Associations of physical activity, screen time with depression, anxiety and sleep quality among Chinese college freshmen. PLoS One. 2014;9:1–5. https://doi.org/10.1371/journal.pone.0100914. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningGiven the self-report method, all variables are at risk to known biases (e.g., social desirability).
“Similarly, given the self-report method, all variables are at risk to known biases (e.g., social desirability).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationStigma is derived from the separation of human groups ("us" vs. "them") and stereotypes associated with group membership.
“As noted by Allport [3], stigma is derived from the separation of human groups (“us” vs. “them”) and stereotypes associated with group membership [3].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [3] Allport GW. The nature of prejudice. Reading, MA: Addison-Wesley; 1954.
Not checked in the free run.
The paper relies on this without support.
The sample of 1912 Chinese university students recruited online is representative of Chinese university students during state-enforced quarantine.
“Recruitment took place online through advertisements on websites and WeChat-based platforms targeting Chinese university students.”
“The sample included 1912 Chinese university students.”
The paper relies on this without support.
The observed associations between predictors and psychiatric symptoms reflect causal risk or protective effects rather than reverse causation or unmeasured confounding.
“We explored risk and protective factors of psychological health, including demographic variables, two known protective factors for mental health (mindfulness, perceived social support), four COVID-specific factors (COVID-19 related efficacy, perceived COVID-19 threat, perceived COVID-19 societal stigma, COVID-19 prosocial behavior) and screen media usage.”
“Risk factors (i.e., positive correlates) for depressive symptoms included financial stress due to COVID-19 (β = 0.119), two COVID-specific risk factors (perceived COVID-19 threat: β = 0.109; perceived COVID-19 societal stigma: β = 0.238), and screen media device usage (β = 0.058).”
The paper relies on this without support.
No meta-analyses or nationally representative survey data are available estimating rates of clinically elevated anxiety or traumatic stress symptoms among Chinese university students.
“To our knowledge, no meta-analyses or nationally representative survey data are available estimating rates of clinically elevated anxiety or traumatic stress symptoms among Chinese university students.”
The paper relies on this without support.
Stigma research has focused on victimized groups.
“Thus far, stigma research has focused on victimized groups.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The review identified 16 studies on college students.
“our findings of five studies on children and 16 studies on college students”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [25]
The 16 college student studies included 15 cross-sectional studies and one cohort study.
“Of the 16 studies remaining, 15 were cross sectional studies and one was a cohort study [16, 19–33].”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [25]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Traumatic-stress threat coefficient does not match its standardized beta
MinorFor a predictor expressed in SD units, B should equal its standardized beta multiplied by the outcome SD. The reported beta of .136 and traumatic-stress SD of 15.98 imply B ≈ 2.173, rather than the Model 2 value of 2.011.
Reported 2.011 · recomputed 2.17328
“| Perceived COVID-19 threat | 2.011 | [1.377, 2.645] | 0.323 | 0.136 | < .001*** | | |”
Depression interaction's added variance is overstated
MinorModel R2 rises from .282 to .288, an increase of .006, or 0.6 percentage points-not 6%.
Reported 0.06 · recomputed 0.006
“Model comparison indicated superiority of Model 3 to Model 2, F = 15.38, p < .001, and the interaction term accounted for 6% additional variance.”
Two different mean ages are reported
MinorThe Results text gives a mean age of 20.28, while Table 2 gives 20.38 for the same sample.
“Average age was 20.28 (SD = 2.10, Median = 20, Range = [18, 49]).”
“| M | 5.20 | 3.59 | 19.83 | 20.38 |”
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The psychological impact of quarantine and how to reduce it: Rapid review of the evidence
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- Authors
- Sun, S., Goldberg, S. B., Lin, D., Qiao, S., & Operario, D.
- Affiliations
- Brown University (US)
- University of Wisconsin–Madison (US)
- Beijing Normal University (CN)
- University of South Carolina (US)
- Corresponding author
- Lin, Danhua
- Venue
- Globalization and Health
- Published
- 2021-01-25
- Volume
- 17
- Issue
- 1
- Pages
- 15-15
- ISSN
- 1744-8603 (ISSN-L)
- PMC
- PMC7829620
- OpenAlex
- W3126110330
- Semantic Scholar
- 56344abdbb723e92ee5d28d38f6bd87d37f35f0e
- Cited by
- 221
- References
- 69
- Citations by year
- 2026: 4 · 2025: 14 · 2024: 38 · 2023: 49 · 2022: 56 · 2021: 60
- FWCI
- 34.77
- Type
- journal article
- Language
- en
- Update notices
- correction (2021-04-26)
- Open access
- gold
- doi.org
- Locations
- Globalization and Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Beijing Normal University (Fighting COVID Research Award)
- National Institute of Mental Health (T32MH078788)
- National Center for Complementary and Integrative Health (K23AT011173, K23AT010879-01)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- COVID-19 pandemic, university students, quarantine, psychiatric symptoms, anxiety, depression, traumatic stress, suicidal ideation, COVID-19 stigma, threat perception, financial stress, mindfulness, social support, screen media use, prosocial behavior, self-efficacy, risk and protective factors
- MeSH terms
- COVID-19, Adolescent, Adult, Anxiety, Mental Disorders, China, Cross-Sectional Studies, Depression, Female, Humans, Male, Middle Aged, Quarantine, Risk Factors, Students, Universities, Stress Disorders, Traumatic, Young Adult, Pandemics, Protective Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.
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