Mental Health Problems during the COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study of College Students in China

Abstract

(1) Background: The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. Vast resources have been allocated to control the pandemic and treat patients. However, little attention has been paid to the adverse impact on mental health or effective mitigation strategies to improve mental health. (2) Purpose: The aim of this study was to assess the adverse impact of the COVID-19 outbreak on Chinese college students' mental health, understand the underlying mechanisms, and explore feasible mitigation strategies. (3) Methods: During the peak time of the COVID-19 outbreak in China, we conducted longitudinal surveys of sixty-six college students. Structured questionnaires collected information on demographics, physical activity, negative emotions, sleep quality, and aggressiveness level. A mixed-effect model was used to evaluate associations between variables, and the mediating effect of sleep quality was further explored. A generalized additive model was used to determine the dose-response relationships between the COVID-19 death count, physical activity, and negative emotions. (4) Results: The COVID-19 death count showed a direct negative impact on general sleep quality (β = 1.37, 95% confidence interval [95% CI]: 0.55, 2.19) and reduced aggressiveness (β = -6.57, 95% CI: -12.78, -0.36). In contrast, the COVID-19 death count imposed not a direct but an indirect impact on general negative emotions (indirect effect (IE) = 0.81, p = 0.012), stress (IE = 0.40, p < 0.001), and anxiety (IE = 0.27, p = 0.004) with sleep quality as a mediator. Moreover, physical activity directly alleviated general negative emotions (β = -0.12, 95% CI: -0.22, -0.01), and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs. (5) Conclusions: (a) The severity of the COVID-19 outbreak has an indirect effect on negative emotions by affecting sleep quality. (b) A possible mitigation strategy for improving mental health includes taking suitable amounts of daily physical activity and sleeping well.

Keywords: coronavirus; mental health; mitigation strategies; physical activity; sleep quality.

Figure 1

The national epidemic trend of the COVID-19 in China from January 23 to March 20, 2020. Note: The subgraph of (a–d) refer to the relationship between date and cumulative confirmed, suspected, cured, and death counts, respectively. The Chinese government declared a lockdown in Wuhan on January 23, which then entered the level-1 emergency response. All provinces across China entered a state of blockade. Thus, we regard January 23, 2020 as the starting point (date 1) of our study and a total of 58 days (from date 1 to date 58) were recorded until the last day of the online survey, March 20, 2020.

Figure 2

Mediation effects of sleep quality on the relationship between COVID-19 deaths and negative emotions. Note: The subgraph of (a–d) indicates the indirect influencing path of the COVID-19 on global negative emotions, stress, anxiety and depression, respectively, with sleep quality playing as a mediator. In Figure (a), indirect effect = 0.81 means that for every 1000 increase in the COVID-19 death count, there is an indirect effect on the global DASS score and an associated increase in the global DASS score of 0.81, indicating an increased level of negative emotions. The same interpretation also holds for other figures. Asterisks indicate significance at the 5% level. MET: the ratio of work metabolic rate to a standard resting metabolic rate. METs: energy expenditure in MET-minutes per week; PSQI: Pittsburgh Sleep Quality Index. Calculation of mediation effects and proportion of mediation was completed in the mediation package of R software, version 3.6.3.

Figure 3

Mediation effects of sleep quality on the relationship between physical activity and negative emotions. Note: The subgraph of (a–d) indicates the direct influencing path of the physical activity on global negative emotions, stress, anxiety and depression, respectively, without sleep quality playing as a mediator. Asterisks indicate significance at the 5% level. So, no mediation effects were significant in this figure. MET: the ratio of work metabolic rate to a standard resting metabolic rate. METs: energy expenditure in MET-minutes per week; PSQI: Pittsburgh Sleep Quality Index.

Figure 4

Relationship between COVID-19 deaths, physical activity and negative emotions, and aggressiveness. Note: The subgraph of (a–d) indicates the relationship between the COVID-19 and global negative emotions, the COVID-19 and aggressiveness, physical activity and global negative emotions, physical activity and depression, respectively. Splines for either the COVID-19 death count or energy expenditure in MET-minutes per week (METs) of physical activity were entered into a mixed-effect model with random effects on individuals. Dashed lines indicate 95% confidence intervals. The global DASS score ranges from 0 to 63, where a larger value means increased negative emotions; depression scores range from 0 to 21, with larger values indicating more depressive emotions; and aggressiveness scores range from 22 to 110, with larger values indicating more potentially aggressive behaviour.