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Coronavirus disease 2019 (COVID-19) broke out in Wuhan, China, in late 2019, and has become a pandemic.1 Unprecedented quarantine was imposed in Wuhan from January 23, 2020, to April 8, 2020, and all schools were closed. Mental health associated with the quarantine is of great concern, especially for adolescents. This study aimed to investigate the prevalence of depression and anxiety and their associations with lifestyle changes among adolescents in Wuhan.
A cross-sectional study of a convenience sample was conducted from March 30, 2020, to April 7, 2020, and data were collected through an online questionnaire using WeChat and QQ apps, which are widely used in China. Eligibility criteria were (1) current residents in Wuhan, (2) age between 12 and 18 years, and (3) not receiving a diagnosis of severe acute respiratory syndrome coronavirus 2 infection. There were 282 junior high schools (219 682 students) and 92 senior high schools (108 679 students) in Wuhan at the time of the survey. We recruited 10 713 students (3.26%) from 27 junior high schools (162 classes) and 11 senior high schools (81 classes) (details of sampling and survey content available on request). All participants provided written informed consent for the survey. Ethics approval was received from the Ethics Committee of the School of Public Health at Fudan University.
The questionnaire collected information on sociodemographic factors and daily life factors during the lockdown period. The Chinese-translated version of the Hospital Anxiety and Depression Scale (HADS) was used to assess levels of anxiety and depression symptoms.2,3 Descriptive and logistic regression analyses were performed using SPSS statistical software, version 20.0 (SPSS Inc). A 2-sided P value less than .05 was considered significant.
Of 7890 participants, 4107 (52.1%) were female. The prevalence was 21.7% (n = 1708) for anxiety and 24.6% (n = 1941) for depression (HADS subscale score >7). Distributions of anxiety and depression according to sociodemographic factors are shown in Table 1.
Table 2 provides the results from logistic regression analysis. After adjustment for covariates, going outside of the home, food insufficiency, perceived discrimination, poor sleep quality, less face-to-face communication with family members, and less pleasure or peace from interests/hobbies/specialties were significantly associated with increased risks of anxiety and depression. More physical activity was significantly associated with a lower risk of depression. The effect of home restrictions on study, screen time, and browsing information about COVID-19 were significantly associated with an increased risk of anxiety.
During the COVID-19 quarantine period, more than 20% of adolescents had anxiety and depression. Long-term home restrictions might have adverse effects on mental health of adolescents because of a sharp change of lifestyles and various stressors, such as fears of infection, frustration, and boredom.5,6
This study revealed that anxiety and depression were closely associated with daily life under home restrictions among adolescents during the COVID-19 pandemic period, especially some factors that could be easily ignored, such as perceived discrimination and ability to study. A multisectoral collaboration has been called on to pay attention to these associations and to take necessary countermeasures.6
The study has several limitations. First, a convenient sampling method could reduce a representativeness of the population. Second, we were not able to evaluate some important cofounding factors, such as levels of community support and parents’ marital status. Third, a cross-sectional design prevents us from assuming any causal relationships between home quarantine–associated factors and the presence of anxiety or depression.
The evidence may help guide the formulation of intervention measures and effective and rapid response to an epidemic of novel infectious disease concerning the mental health of adolescents.
Corresponding Author: Jiwei Wang, PhD, School of Public Health, Fudan University, No.130, Dong’an Road, Xuhui District, Shanghai, China 200030 (email@example.com).
Accepted for Publication: July 29, 2020.
Published Online: January 19, 2021. doi:10.1001/jamapediatrics.2020.5499
Author Contributions: Drs Jiang and J. Wang had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Li and Zhang contributed equally.
Concept and design: Li, J. Wang, Ozaki, Jiang.
Acquisition, analysis, or interpretation of data: Li, Zhang, J. Wang, Q. Wang, Chen, Jiang.
Drafting of the manuscript: Li, Zhang, J. Wang, Jiang.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Li, Zhang, J. Wang.
Obtained funding: J. Wang.
Administrative, technical, or material support: Li, J. Wang, Jiang.
Supervision: J. Wang, Jiang.
Conflict of Interest Disclosures: Drs Ozaki receives personal fees from the Medical Network Systems (MNES) outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by the Shanghai Health and Planning Commission’s fourth round of public health 3-year action plan (project 15GWZK1001) and the Independent Innovation Research Foundation of Huazhong University of Science and Technology (Humanities and Social Sciences) (project 2017WKYXQY009).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: We thank Jinming Yu, PhD (School of Public Health, Fudan University, Shanghai, China), for assistance in the original study design. We would like to acknowledge assistance from Tetsuya Tanimoto, MD (Medical Governance Research Institute, Tokyo, Japan), Yasuhiro Kotera, MA (University of Derby, Kedleston Road, Derby, United Kingdom), and Toyoaki Sawano, MD (Sendai City Medical Center, Sendai, Miyagi, 983-0824, Japan), in writing and revising the manuscript. These individuals were not compensated.
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Li W, Zhang Y, Wang J, et al. Association of Home Quarantine and Mental Health Among Teenagers in Wuhan, China, During the COVID-19 Pandemic. JAMA Pediatr. 2021;175(3):313–316. doi:10.1001/jamapediatrics.2020.5499
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