# Mental Health Symptoms Among Chinese College Students Following the Lifting of COVID-19 Restrictions: A Serial Cross-Sectional Study in Guangdong Province, China

## TL;DR

This study found that mental health symptoms among Chinese college students worsened after pandemic restrictions were lifted in 2022.

## Contribution

The study provides new insights into the mental health impacts of post-pandemic life on college students in China.

## Key findings

- Mental health symptoms like anxiety and depression increased significantly after restrictions were lifted.
- Students with a history of infection or those with extreme protective behaviors faced higher mental health risks.
- Suicidal ideation rose by 31.8% after restrictions were lifted compared to the initial pandemic phase.

## Abstract

Background/Objectives: To assess the mental health of Chinese college students following the lifting of COVID-19 restrictions in December 2022. Methods: A three-wave cross-sectional study was conducted among students from 22 colleges in Guangdong, China, at three time points: Onset of COVID-19 (February 2020; T1; initial survey wave), during restrictions (June 2021; T2), and after restrictions (March to April 2023; T3). Participants at each wave were 164,101, 86,767, and 130,285, respectively. The standardized prevalence rates of depression, suicidal ideation (SI), anxiety, insomnia, acute stress, and fear of COVID-19 after restrictions were compared with those from the initial survey wave and restriction periods. Multivariate logistic regression was used to identify associated risk factors. Results: After restrictions were lifted, standardized prevalence rates of mental symptoms were as follows: anxiety (13.5%), depression (19.9%), insomnia (11.8%), acute stress (19.7%), fear of COVID-19 (16.2%), and suicidal ideation (31.8%). The standardized prevalence rates at T3 were higher than those at T1, with absolute increases of 10.9% for anxiety, 13.9% for depression, 9.1% for insomnia, and 23.5% for suicidal ideation. Acute stress showed a V-shaped pattern, with lower prevalence during the restriction period compared to T1, followed by an increase at T3. Fear of COVID-19 declined after the initial phase and remained stable. Students with a history of infection, those perceiving greater pandemic impact, and those who either neglected or excessively engaged in protective behaviors were at elevated risk for mental health symptoms. Conclusions: Our findings highlight the long-term adverse effects of the pandemic at the population level on Chinese college students’ mental health. Continuous monitoring, early prevention, and accessible mental health care should be prioritized in the coming years.