Abstract

Background

     The outbreak of Coronavirus disease (COVID-19) in 2019 and the resulting quarantine may have increased the prevalence of mental health problems in adolescents. The aim of this study was to explore the association between the effects of home-based learning during the pandemic and the risks of depression, anxiety, and suicidality among junior and senior high school students.

Methods

     An online survey using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) was conducted between 12 to 30 April 2020, on a total of 39,751 students. Multivariable logistic regression analysis was used to analyze the risk factors of associated depression, anxiety and suicidality during the pandemic.

Results

     Prevalence of depression, anxiety symptoms and suicidality found was 16.3% (95% CI: 16.0, 16.7), 10.3% (95% CI: 10.0, 10.6) and 20.3% (95% CI: 19.9, 20.7), respectively. Participants with female gender and in junior high school, with poor overall sleep quality and poor academic performance and very worried about being infected during COVID-19 were highly associated with the risk of depression, anxiety symptoms and suicidal ideation (all P<0.001).

Conclusions

     Prevalence of self-reported mental health problems for adolescents using home-based distance learning was high. Implementing measures (e.g., wearing face masks) and spending only moderate time focusing on COVID-19-related information could be protective factors for mental health. These results provide suggestions for teachers and policy makers regarding adolescent improving sleep quality (sufficient sleep) and academic performance and reducing worry about pandemic during quarantine to prevent mental health problems.

Introduction

     Since the first outbreak of the Coronavirus disease (COVID-19) at the end of 2019, the COVID-19 pandemic was listed as a global public health emergency of international concern by the World Health Organization (WHO, 2020). In order to contain the spread of COVID-19, most recently, the Chinese Government issued a stay-at-home order, which meant that mass quarantine was mandatory during the initial outbreak of COVID-19 (Brooks et al., 2020). For example, only residents were allowed to enter residential communities, the wearing of face masks was made compulsorily, and non-essential community services were shut down (Leung et al., 2020). Meanwhile, 107 countries as estimated by the UN Educational, Scientific and Cultural Organization (UNESCO) on 18 March 2020, had implemented national school closures related to COVID-19, affecting 862 million children and adolescents (UNESCO, 2020). In particular, there were more than 220 million children and young people confined to their homes in China, according to the Ministry of Education of China (Ministry of Education of China, 2020). Normal daily life shifted for adolescents to home-based distance learning models, which has resulted in substantial disruption to the lives of students and their families and which may have longer-term consequences for adolescent health (Golberstein et al., 2020). There are obvious advantages to remote learning, e.g., accessibility and comfort during online learning, however, the limitations of inefficient learning, lack of eye contact and feedback from teachers, inattention and the difficulty in maintaining academic integrity are also of concern (Mukhtar et al., 2020). Although adolescence is a transitional and critical developmental period with brain and body maturation, students still faced further challenges in terms of losing structure and support, routine social connections, social distancing and loneliness, less physical activity, spending more time on screens, increased irregular sleep patterns, and less favorable diets, resulting collectively in weight gain and a loss of cardiorespiratory fitness (Brazendale et al., 2017; Loades et al., 2020). These challenges have been associated with increased mental health problems in adolescents, including an increase in anxiety, depression, loneliness and a loss of motivation and purpose (Caspi et al., 2006). Therefore, adolescent mental health needs to be prioritized during the COVID-19 pandemic.

Conclusions

     The current findings indicate that the prevalence of depression, anxiety symptoms and suicidal ideation is relatively high, particularly for respondents who are female and in junior high school, with poor academic performance and negative health status, spending more than three hours focusing on COVID-19 information, very worried about being infected and those who did not implement preventive measures. Additionally, high risk of mental health problems is indicated in students who had poor overall sleep quality, little or no physical activity and who were spending more than five hours on the internet. These study findings contribute to a greater understanding of mental health problems during pandemics in both junior and high school students, especially in terms of suicidal ideation. The research will help to identify risk factors in the mental health of adolescents and provides some suggestions to prevent and manage according to the above factors, such as spending less time online, taking enough physical exercise (30–۶۰ minutes per day), and improving sleep quality (for example, taking sufficient sleep, keeping exercise). Further longitudinal studies of the long-term effects of the COVID-19 pandemic and quarantine on adolescents are needed to expand on this research.