Abstract
Chinese university students are at high risk for depressive symptoms and the ongoing coronavirus disease 2019 (COVID-19) pandemic may have exacerbated the mental health of university students. However, existing studies on depressive symptoms in Chinese university students during the COVID-19 pandemic reported a wide range of prevalence estimates, making mental health planning for this population difficult. The objective of this study was to conduct a systematic review and meta-analysis of surveys that assessed the prevalence of depressive symptoms in Chinese university students amid the COVID-19 pandemic. Major Chinese (CNKI, Wanfang, VIP) and English (PubMed, Embase, PsycInfo) databases and preprint platforms were searched to identify cross-sectional studies containing data on the prevalence of depressive symptoms in Chinese university students during the pandemic. Two authors independently retrieved the literature, evaluated the eligibility of potential studies, assessed the risk of bias (RoB) of included studies, and extracted data. RoB was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. In total, 1177 records were retrieved, and 84 studies involving 1 292 811 Chinese university students during the pandemic were included. None of the included studies were rated as completely low RoB. Statistically significant heterogeneity in the prevalence estimates of included studies was detected (I2 = 99.9%, p < 0.001). The pooled prevalence of depressive symptoms was 26.0% (95%CI: 23.3-28.9%), which was significantly higher in female than in male students (30.8% v. 28.6%, p < 0.001), in postgraduates than in undergraduates (29.3% v. 22.9%, p < 0.001), in students living inside than in those living outside the COVID-19 epicentre (27.5% v. 22.3%, P < 0.001), in students from universities at the epicentre than in those from universities outside the epicentre (26.2% v. 23.1%, p < 0.001), in students who had close contact with COVID-19 than in those who did not (46.0% v. 25.0%, p < 0.001), and in students who had acquaintances or relatives infected with COVID-19 (39.7% v. 24.0%, p < 0.001) than in those who did not. Five sources of heterogeneity were identified from the subgroup analysis: survey period, % of males among the survey sample, scale of depressive symptoms, cutoff score of the scale and level of RoB. Over one-fourth of Chinese university students experienced depressive symptoms during the COVID-19 pandemic. Mental health services for this population should include periodic evaluation of depressive symptoms, expanded social support and psychiatric assessment and treatment when necessary. It is also necessary to design depression prevention programmes that target higher-risk cohorts of university students.
Highlights
Studying in university is an important life stage during which a person moves from family dependence to independence and socialisation
The inclusion criteria for eligible studies were (a) cross-sectional surveys or baseline surveys of cohort studies with meta-analysable data; (b) study subjects were Chinese university students, including overseas students and postgraduates; (c) the presence of depressive symptoms was assessed with standardised instruments and (d) the study was conducted during the COVID-19 pandemic
The Nine-item Patient Health Questionnaire (PHQ-9) was the most common instrument to assess the presence of depressive symptoms (n = 37), followed by Zung’s Self-rating Depression Scale (SDS) (n = 22), the depression subscale of the Symptom Checklist-90-Revised (SCL-90-R) (n = 8), the depression subscale of the Depression, Anxiety and Stress Scale – 21 Items (DASS-21) (n = 7) and the Center for Epidemiologic Studies – Depression Scale (CES-D) (n = 7)
Summary
Studying in university is an important life stage during which a person moves from family dependence to independence and socialisation. The transition is challenging because of the high level of academic and employment stress and the prevalent interpersonal, romantic and emotional problems in this particular stage for university students (Zhao et al, 2015; Liu et al, 2017; Zhang et al, 2020a). Due to China’s strict examination-oriented education system, many university students have little training in interpersonal communication, problem solving and teamwork skills before entering university. This population has difficulties in adapting to the university environment and is more likely to feel unconfident and confused about the future (Kirkpatrick and Zang, 2011; Hu, 2018). Chinese university students are at high risk for common
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