COVID-19 was first reported in Wuhan, China in early December 2019. The rapid development of the pandemic has attracted attention worldwide. The World Health Organization (WHO) declared this outbreak to be a public health emergency of international concern on January 31, 2020 (1). As of 24:00 on February 12, 2020, there were a total of 52,526 confirmed cases and 1,367 deaths in China (2), and confirmed cases had been reported in more than a dozen other countries. To contain the spread of the virus, Wuhan had been placed in lockdown, causing public's fears.

In addition to severely threatening people's physical health, the pandemic may also exacerbate their mental health disorders (3). Previous studies showed that abnormal psychological phenomenon was common during the SARS crisis, and depression was one of the most common mental disorders triggered by emerging infectious disease (EID) (4, 5). Recently, a Chinese study found that more than 50% of the 1,210 respondents from 194 cities reported moderate to severe (M/S) levels of psychological difficulties due to the COVID-19 outbreak, with about 16% suffering from symptoms of depression (6).

College students may be the most susceptible population for depression, since their psychological development is incomplete in the stage of transition from late adolescence to early adulthood (7–10). A meta-analysis involving 28,218 Chinese college students of 26 studies showed that 23.9% of college students had depression symptoms (11). Such a problem may become more serious during the pandemic, due to strict isolation measures, delays in school opening across the country, and lack of knowledge and skills on diseases prevention and control. A survey conducted in China found that 25.3% of 933 students from universities in Beijing and Wuhan had symptoms of depression during COVID-19 (12). Similarly, a survey of students from 85 different universities in Guangdong, China showed that 40.5% of 4,164 students were in a state of depression (13). Without early intervention, these depressive symptoms are more likely to develop into long-term depression, and lead to severe psychological disorders (14, 15).

College students' depression has been reported to be affected by many factors, including demographic factors (e.g., gender, personality type, education attainment, major, etc.) (16–18), and factors related to the pandemic (e.g., self-perceived risk of infection, knowledge and skills on diseases prevention and control, and satisfaction with government prevention and control measures, etc.) (19, 20). However, few studies investigated depression symptoms and its influencing factors among college students in China with a large sample during the early outbreak. Furthermore, most of the research related to mental health during the early COVID-19 outbreak focused on medical staff or patients (21, 22). Detecting early-onset mental health problems among college students may have many benefits, especially for campus health services and mental health policymaking (23, 24). Therefore, our study aims to conduct an online survey to investigate the self-reported depression status of Chinese university and college students, and to identify its influencing factors in a large sample size. Through this study, we hope to be able to provide appropriate management strategies to improve depressive symptoms for university and college students during the pandemic.

In our study, the proportion of self-reported depression symptoms was 65.2%, where mild and M/S accounted for 53.7 and 11.5%, respectively. Our finding is higher than that of several online surveys conducted in the general population during the COVID-19 pandemic (17.2–37.1%) (6, 31, 32), and it is also higher than a study conducted in the UK among college students (46.5%) (33). Moreover, the mean score of self-reported depression was 54.8 ± 9.0, which is higher than the Chinese norm (41.88 ± 10.57) and a study conducted in Shandong, China (42.47 ± 8.61) (p < 0.05) (34). Possible explanations for the higher proportion and mean score of self-reported depression symptoms in our study are that Chinese students are more likely to suffer from depressive symptoms because of fear caused by widespread media coverage on an increasing number of confirmed and suspected cases in China, lack of relevant knowledge and skills on prevention and control, and shortage of specific treatment. However, our result is lower than the study in Guangdong, China (79.9%) (35), which was conducted among 488 medical students using the Depression Status Inventory (DSI). It is likely that our study involved other majors' students besides medical students and we used a different measurement scale. Previous studies have proven that compared to students in other majors, medical students were susceptible to greater levels of depression due to the heavy burden of study, absence of any leisure activities, and exposure to death and suffering (36, 37).

Consistent with previous studies, female students self-reported more severe depression symptoms than males (38, 39). One possible reason is that female students are more emotional and sensitive to severe events than males (40). Likewise, a study during the period of SARS showed that female students' understanding of SARS was more perceptual, and they lacked a rational perspective on the infection and treatment of SARS (41).

Compared with undergraduates and students with a higher educational level, junior college students were more likely to suffer from M/S self-reported depression symptoms due in part to lacking knowledge and skills on disease prevention and control. They may also experience more stress because of low academic qualification when they are looking for a job. Therefore, they are prone to have depressive symptoms and psychological distress during the pandemic. In addition, higher concern about the outbreak and having health literacy were protective factors for M/S self-reported depression symptoms. Students who are more concerned about the pandemic may have a higher understanding of the pandemic. Previous research among college students during SARS showed that students with higher cognition had a lower risk of depression symptoms (42, 43).

Our study showed that students who were eager to go back to school or those highly impacted by the outbreak were more likely to suffer from M/S self-reported depression symptoms. To contain the pandemic, the education department postponed school opening. Staying at home for a long time may increase the risk for self-reported depression symptoms. Their lifestyle and study plan may be correspondingly changed, further increasing the risk for self-reported depression symptoms among college students. Our study also found that partially introverted students had a higher risk of suffering from more severe self-reported depression symptoms, which is consistent with most previous studies (17, 44, 45). Introversion is linked to decreased help-seeking behavior, and introverts are thus more likely to turn inward to cope with negative emotions (46, 47). Over time, the negative impacts caused by the pandemic may exacerbate their depression.

Another finding in our study was that students who had lower satisfaction with prevention and control measures, or those who had higher self-perceived risk of infection were more prone to have self-reported M/S depression symptoms. Similarly, a previous study showed that people with confidence in government measures were less likely to have emotionally distressful responses during the avian influenza epidemic (20). Due to the lack of understanding the pandemic, students who perceived higher risk of infection were more likely to be affected by the pandemic, resulting in a higher status of self-reported depression.

Despite these advantages, there were several limitations in our study. Firstly, our data were self-reported via an online network, and the SDS scale was used to detect and screen depression symptoms, which may be less accurate than rating from a clinical psychologist or psychiatrist. Secondly, this is a cross-sectional study; therefore, associations cannot be viewed as causal relationships. Future research should consider a longitudinal design to follow up on the change in the students' psychological status to provide necessary support. Thirdly, convenience sampling was used in our study, which was not based on a random selection of the sample; thus, the study population did not reflect the actual pattern of the general population. Finally, due to the limitation of an online survey, it was impossible to investigate more factors in our study.

In this study, university and college students had a higher proportion of self-reported depression symptoms than expected. The influencing factors of self-reported depression symptoms were multifaceted, including socio-demographic factors and those related to the pandemic. Governments should provide more disease prevention and control services to improve knowledge and skills on disease prevention for college students, and boost their confidence in fighting against the pandemic. School managers should also pay more attention to female and junior college students in health education and promotion.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

YJ and WH performed material preparation and data collection. YJ, WH, YW, and XJ performed statistical analysis. YJ writing the manuscript. LX, YW, JZ, and WQ helped revise the manuscript. LX and AN directed the study. All authors have contributed significantly to the manuscript, read, and approved the final manuscript.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.