The COVID-19 pandemic was a major public health emergency from 2019 to 2023, not only because of the virus’ effects on physical health, but also because the psychological threat of the pandemic and its accompanying public health measures invoked high levels of chronic life stress. This, in turn, led to global increases in mental health problems, including increased prevalence of anxiety and depression disorders (1, 2). Especially during the early stages of the pandemic, the eyes of the world were directed toward China, that the pandemic had started there. Given China’s large population and the fact that China was the epicenter of the COVID-19 pandemic, understanding its public health situation at this moment in time is of particular significance. The purpose of the present study was to investigate Chinese college students’ mental health during the first 3 months of the pandemic in China (January–March 2020) and to address the potential protective role of family functioning therein.

Life during the COVID-19 pandemic presented unique challenges for young adults worldwide, including Chinese college students. There were widespread concerns regarding the risk of contracting the virus and its potential impact on physical health (3–6). Additionally, daily routines were significantly disrupted by extensive public health measures aimed at curbing the spread of the virus, such as mask-wearing, social distancing, and the closure of public spaces like shops, schools, and restaurants. Adjusting to these changes was particularly stressful for the general population and young adults alike (7, 8). Young adults typically face elevated risks of psychological issues due to their lower levels of psychological maturity and distress tolerance (9). Furthermore, young adulthood represents a crucial developmental period characterized by rapid shifts in personality functioning (10). Persistent challenges in coping with stress during young adulthood may therefore lead to enduring vulnerabilities to mental and physical health conditions throughout the lifespan (11, 12).

Several strands of evidence highlight the heightened coping challenges faced by young adults during the COVID-19 pandemic. In a systematic review and meta-analysis involving 13,247 nursing students, Mulyadi et al. (13) found elevated rates of mental health issues, including depression (52%), fear (41%), anxiety (32%), stress (30%), and sleep disorders (27%) amidst the pandemic. Similarly, an international study encompassing over 134,000 college students across 28 countries revealed various COVID-19-related concerns among students, such as fear of virus transmission within their social circles, increased loneliness, reduced motivation, disrupted sleep patterns, and symptoms of anxiety and depression (14). Furthermore, a survey examining the mental health status of 3,881 college students during the initial 3 months of the pandemic in Guangdong, China, documented incidence rates of clinical depression and anxiety at 21 and 26%, respectively (15).

Despite the pervasive challenges posed by the COVID-19 pandemic, it appears that certain young adults were adapting effectively to their new life situation. One key resource in this regard may be the social support network of young adults, particularly their family. Family functioning encompasses the social and structural aspects of the overall family environment, including interactions and relationships within the family (16). Effective family functioning provides various psychological benefits, such as promoting secure attachment (17), enhancing a sense of belonging (18), and offering ample opportunities for social–emotional support (19). Moreover, within Chinese culture, the family holds paramount importance as one of the foundational social institutions, with traditional Chinese philosophy emphasizing harmony within the family as a fundamental virtue (20). Consequently, family functioning may exert a more pronounced influence on the mental health of Chinese adolescents (21).

In line with this perspective, a young adults’ healthy development is closely linked to strong family functioning (22–24). Children raised in well-functioning families are less prone to mental health issues compared to those from dysfunctional family environments (25). Moreover, research involving 988 adolescents (aged 11–17 years) in Monteria public schools found that better family functioning was associated with improved mental and physical health outcomes (26). Finally, a meta-analysis of 8,646 children revealed a negative association (r = −0.22) between family function and post-traumatic stress disorder (27), suggesting that family function can protect children’s mental health against excessive stress.

In view of the aforementioned findings, family functioning may have a protective role when people are dealing with major public health threats such as the COVID-19 pandemic. Generally speaking, in the aftermath of natural or human-made disasters, children tend to display better mental health when they are in a more (versus less) supportive family environment (28). More directly to the point, research among a sample of 135 Latinx adolescents found that better family resilience was associated with improved mental and physical health outcomes during the COVID-19 pandemic (29). A study on Puerto Rican adolescents in the U.S. also found that family financial stress had an impact on COVID-19 pandemic related mental health (30). Finally, a study of 1,254 Chinese university students in the Shanghai region (an 8-h drive to Wuhan, where the pandemic started) observed that family cohesion was negatively associated with adverse stress consequences during the third month of the COVID-19 pandemic (31).

In the present study, we sought to gain more insight into the potentially protective role of family functioning for Chinese young adults during the initial stages of the COVID-19 pandemic. Specifically, we investigated family function among a sample of more than 1,500 Chinese university students: (1) during the first 3 months of the COVID-19 pandemic; (2) in a Chinese region (Hunan) close (i.e., a 2-h drive) to the region from where COVID-19 first broke out (Wuhan); and (3) including a comprehensive and well-validated measure of mental health as our primary outcome variables. The present study thus goes beyond prior published studies (31, 32) that were conducted somewhat later in time, in regions farther removed from the epicenter of the pandemic, and did not include direct measures of mental health. In line with prior research, we hypothesized that better (rather than worse) family functioning would be positively associated with mental health. A second, more exploratory, objective of the present study was to use latent profile analysis within a regression mixture model to identify mental health subgroups within the sample of Chinese college students (33).

The present study examined the association between family functioning and pandemic-related mental health among Chinese college students’ during the first 3 months of the COVID-19 pandemic. This period marked a unique phase in China’s history, characterized by unprecedented public health challenges, such largescale home quarantine for the entire population. Our findings showed that, as expected, better family functioning was associated with lower pandemic-related psychological symptoms. Additionally, higher monthly income was associated with fewer symptoms. Moreover, the results indicated that for college students, each one-point increase in family functioning score corresponded to a respective 16 and 24% greater likelihood of belonging to the low-level mental health symptom cluster compared to the medium or high-level symptom clusters. Taken together, these findings support the idea that better family functioning buffers the psychological effects of a major public health crisis, in this case among Chinese college students impacted by the stress of the COVID-19 pandemic.

The observed protective effects of family functioning in the present study align with prior findings among Chinese young adults coping with the COVID-19 pandemic (31, 32, 47) and the broader public health literature (37, 48–50). When facing a major public health crisis like the COVID-19 pandemic, people are likely to turn to their social networks for practical and emotional support. Among these networks, the family holds particular significance, perhaps especially in China, where it has traditionally occupied a central role in cultural life (20). Notably, the present study was conducted during China’s largest family-oriented holiday, the ‘Spring Festival’ (similar to the Western Christmas), so that family life was highly salient at the time of the study. Moreover, during periods of lockdown and amidst a public health crisis, the functioning of families may further gain in psychological significance. Thus, the family serves as a vital coping resource in navigating through public health emergencies.

Moreover, cultural nuances may shape how mental health symptoms are perceived and expressed. Stigma surrounding mental illness and help-seeking behaviors can vary across cultures, influencing individuals’ willingness to disclose psychological distress and seek professional support (51). Additionally, an intervention study with Iranian college athletes indicated that COVID-19 had an impact on athletic performance (52), echoing findings from a separate large-scale international study that also highlighted effects on athletes’ diet quality (53). Considering the intricate nexus between mental and physical health (54), which becomes even more pronounced during stressful events like a global health crisis, our study emphasizes the influence that physical health difficulties during the COVID-19 pandemic may have on mental well-being, highlighting the critical role of family functioning in maintaining overall health.

In developing public health policies, it is useful to know whether a population is composed of different meaningful subgroups. Our latent profile analysis revealed three distinct clusters characterized by low, middle, and high levels of symptoms. These clusters hold significance as they may represent groups with varying psychological needs. Students in the high-level symptom cluster exhibited elevated scores across all symptoms, indicating a heightened need for social and emotional support or targeted psychological counseling during public health emergencies (55). The middle-level symptom cluster, being the largest group, warrants attention as individuals within this cluster may be susceptible to transitioning into the high-level symptom cluster. Providing timely guidance and support to students in this cluster may prevent such transitions, potentially leading to a shift toward the low-symptoms cluster. However, further research is required to validate this hypothesis. As expected, fear in response to the COVID-19 pandemic emerged as the highest-scoring symptom across all clusters compared to other symptoms. Studies have indicated that nearly half of college students reported experiencing some degree of fear during the COVID-19 pandemic (56).

Amidst public health crises like the COVID-19 pandemic, a supportive family environment is particularly crucial as it serves as a psychological buffer against stress and challenges. Policymakers should consider developing and implementing policies that bolster family support systems, enhance awareness of the significance of family functioning through public health campaigns, and allocate resources to mental health services that ensure families have the necessary support to deal with stress. Educators can strengthen students’ psychological resilience by incorporating family engagement strategies and mental health education into curricula, ensuring students and their families are informed about available mental health resources. Additionally, mental health professionals should adopt family-centered therapeutic approaches (57) and develop targeted interventions that address the unique stressors of crises, focusing on strengthening family bonds and coping mechanisms. Overall, supporting students during crises requires a comprehensive approach that not only focuses on individual mental health but also values the well-being of the family as a key factor in mitigating the psychological impacts of such crises.

The current study inevitably has limitations. First, although the sample size of more than 1,500 participants was substantial, it was limited to college students from Hunan Province in China, potentially limiting the generalizability of the findings to other regions. Future research may include a broader and more varied geographic samples, longitudinal tracking, cross-cultural comparative analyses, and the adoption of mixed-methods for a comprehensive understanding. Second, the present study design was cross-sectional, precluding the testing of causal relationships between family functioning and pandemic-related psychological symptoms. It is conceivable that the relationship between family functioning and symptoms is bidirectional, with better family functioning serving as a protective factor against symptoms, and less severe symptoms facilitating better family functioning (58, 59). Future research should test the causal impact of family functioning through longitudinal or experimental designs, including the investigation of family-based interventions (60). Third, given the present study’s reliance on self-reported data, which is prone to biases like memory distortion and social desirability, future research could benefit from a multi-method approach that combines quantitative and qualitative data, including in-depth interviews or focus groups, to gain a deeper understanding of family functioning and mental health.

Despite these caveats, the present study contributes to the growing body of evidence indicating that family functioning provides psychological protection against the adverse effects of public health crises on mental health among young adults (31, 32, 61, 62). The present findings provide a unique window into the mental health of young adults in China during the first 3 months of the COVID-19 pandemic, a time when young adults were largely living in quarantine with their family. When managing largescale public health crisis, policy makers will do well to consider the protective role of family functioning in mental health.

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found at: https://osf.io/85qp3/.

The studies involving humans were approved by Hunan Agricultural University ethics committee. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

ZZ: Conceptualization, Data curation, Funding acquisition, Writing – original draft. KH: Methodology, Writing – review & editing, Validation. IV-L: Supervision, Writing – review & editing, Validation. SK: Funding acquisition, Project administration, Supervision, Writing – review & editing.