Data_Sheet_1_The correlation between lifestyle health behaviors, coping style, and mental health during the COVID-19 pandemic among college students: Two rounds of a web-based study.doc

BackgroundDuring the last months of 2019, worldwide attention has focused on a pandemic of COVID-19, and the pandemic spread rapidly, becoming a public health emergency of international concern. The Chinese government has quickly taken quarantine measures and the drastic measures incurred to curtail it, which could have harmful consequences for everyone's behavior and mental health.
ObjectiveThis study aimed to investigate the correlation of influencing factors and mental health symptoms among Chinese college students according to two rounds of surveys during the COVID-19 pandemic.
Materials and methodsThis study was divided into two stages of cross-sectional investigation. In February 2020 and May 2020, two cross-sectional surveys were conducted on college students in the above areas by means of cluster sampling. From February 4 to February 12, 2020, 14,789 college students completed the first round of online study from 16 cities and universities in 21 in China, excluding participants who completed the questionnaire, and finally included 11,787 college students. After 3 months, we also conducted a large-scale questionnaire survey based on the first study area to observe the behavioral changes and psychological symptoms of college students within 3 months. Using the convenience sampling method, a survey on the cognitive and psychological status of COVID-19 among college students was conducted in 21 universities in 16 regions in May 2020. The regions among the two surveys are divided into Wuhan (District 1), neighboring Hubei (District 2), first-tier cities, namely, Beijing, Shanghai and Guangzhou (District 3), and other provinces (District 4).
Results(1) In the first survey, the average age of the participants was 20.51 ± 1.88 years. One-third of the college students were male. In total, 25.9 and 17.8% of college students reported depression and anxiety symptoms, respectively. College students, who reported higher ST, lower PA, higher soda beverage and tea beverage intake, have Chinese herbal medicine and vitamin drinking, and decreased frequency of diet had higher depression and anxiety symptoms. Moreover, infection risk, perceived resistance to COVID-19, concerns about physical symptoms, family/friends directly/indirectly contacted with confirmed cases, and seeking psychological counseling had significant associations with anxiety and depression symptoms. (2) In the second round of surveys, 6803 males (41.7%) and 9502 females (58.3%) had a mean age of 20.58 ± 1.81 years. The prevalence of depressive symptoms and anxiety symptoms during COVID-19 was 30.7 and 23.9%, respectively. (3) In both surveys, college students who reported having higher ST, lower PA, higher soda beverage and tea beverage intake, Chinese herbal medicine and vitamin drinking, and decreased frequency of diet also had higher depression and anxiety symptoms. Coping styles with COVID-19 partially mediate the association between some related lifestyle behaviors and anxiety and depression. The results of the conditional process model analysis support our hypothesis that lifestyle behaviors, and coping styles are both predictors of anxiety and depression symptoms, with both direct and indirect effects moderated by gender level. In logistic regression analysis, the correlation of depression and anxiety in the second rounds of the survey was higher than that in the first survey. In two surveys, there was a correlation between lifestyle health behaviors and coping style, gender and mental health.
ConclusionsOur findings demonstrated that the prevalence of anxiety and depression in the two rounds of surveys was different, and the prevalence in the second round was higher than that in the first round, as well as that in the two rounds of surveys. All survey identified that unhealthy lifestyle behaviors were positively associated with depression and anxiety symptoms. Compared with the emerged city of risk areas, other pandemic regions have a lower risk of mental health problems. The survey findings complement each other. Lifestyle health behaviors and coping style alleviated mental health symptoms. COVID-19-related social stressors were positively associated with mental health symptoms. The study also suggests that at the beginning of the pandemic, the effective management of college students' mental health problems, corresponding coping measures and maintaining a good lifestyle play a key role in the prevention and control of other cities. Understanding the college students' lifestyle behaviors during COVID-19 lockdown will help public health authorities reshape future policies on their nutritional recommendations, in preparation for future pandemics.

研究背景
2019年末数月间，新型冠状病毒肺炎（COVID-19）疫情引发全球广泛关注，疫情快速蔓延，成为国际关注的突发公共卫生事件（public health emergency of international concern）。中国政府迅速采取检疫措施及严苛的疫情防控举措以遏制疫情，但此类措施可能对公众行为与心理健康产生不利影响。
研究目的
本研究旨在借助新冠疫情期间开展的两轮调查，探究中国大学生心理健康症状及其影响因素之间的关联。
研究对象与方法
本研究分为两阶段横断面调查（cross-sectional investigation）。研究分别于2020年2月与2020年5月，采用整群抽样（cluster sampling）方法，针对相关区域的大学生开展两轮横断面调查。
2020年2月4日至2月12日，来自中国21个省份16座城市的14789名大学生参与了首轮在线调查，剔除未完成问卷者后，最终纳入11787名大学生。3个月后，基于首轮研究覆盖区域开展大规模问卷调查，以观察大学生在3个月内的行为变化与心理症状。
2020年5月，针对中国16个地区21所高校的大学生，采用方便抽样（convenience sampling）方法开展新冠疫情相关认知与心理状况调查。
本研究将两次调查覆盖地区划分为四类：武汉地区（区域1）、湖北省邻近地区（区域2）、一线城市（北京、上海、广州，区域3）及其他省份（区域4）。
研究结果
(1) 首轮调查中，研究对象平均年龄为20.51±1.88岁，其中约三分之一为男性。分别有25.9%与17.8%的大学生报告存在抑郁症状与焦虑症状。报告更长屏幕使用时间（ST）、更低体力活动（PA）水平、更高含糖饮料与茶饮摄入量、服用中草药及维生素补充剂，且饮食频率降低的大学生，其抑郁与焦虑症状得分更高。此外，感染风险感知、对新冠病毒的抵抗力感知、对身体症状的担忧、家人/朋友直接/间接接触确诊病例情况，以及寻求心理咨询服务，均与焦虑及抑郁症状存在显著关联。
(2) 第二轮调查中，共纳入男性6803名（占比41.7%）、女性9502名（占比58.3%），平均年龄为20.58±1.81岁。新冠疫情期间抑郁与焦虑症状的检出率分别为30.7%与23.9%。
(3) 两轮调查均显示，报告更长屏幕使用时间（ST）、更低体力活动（PA）水平、更高含糖饮料与茶饮摄入量、服用中草药及维生素补充剂、饮食频率降低的大学生，其抑郁与焦虑症状得分更高。应对新冠疫情的应对方式在部分生活方式相关行为与焦虑、抑郁症状之间存在部分中介效应（mediation effect）。调节过程模型（conditional process model）分析结果验证了本研究假设：生活方式行为与应对方式均可作为焦虑与抑郁症状的预测因素，且直接与间接效应均受性别水平调节。逻辑回归分析（logistic regression analysis）结果显示，第二轮调查中抑郁与焦虑症状的关联强度高于首轮调查。两轮调查均显示，生活方式健康行为、应对方式、性别与心理健康状况存在关联。
研究结论
本研究结果显示，两轮调查中焦虑与抑郁症状的检出率存在差异，第二轮调查的检出率高于首轮调查，且两轮调查整体均呈现一致结果。两项调查均证实，不健康的生活方式行为与抑郁、焦虑症状呈正相关。与疫情风险核心区域相比，其他疫情区域的心理健康问题风险更低。两项调查结果互为补充。健康生活方式行为与积极应对方式可缓解心理健康症状。与新冠疫情相关的社会应激因素与心理健康症状呈正相关。本研究同时表明，在疫情初期，有效管控大学生心理健康问题、采取针对性应对措施及维持良好生活方式，对于其他城市的疫情防控具有关键作用。了解新冠疫情封控期间大学生的生活方式行为，有助于公共卫生部门调整未来的营养推荐政策，为应对未来可能发生的疫情做好准备。