The Effects of COVID-19 on Anxiety and Depressive Symptoms Among Chinese College Students: Chain Mediation of Three Long COVID-19 Symptoms

Long COVID has become a public health issue, and anxiety and depressive symptoms have been on the rise among young people since the COVID-19 pandemic. The primary purpose of this study was to survey the status of COVID-19 infection, long COVID, and mental health among Chinese college students after China lifted the dynamic zero-COVID policy on December 7, 2022. The secondary purpose was to explore the mediation effect of long COVID on the relationship between COVID-19 and anxiety and depressive symptoms. A total of 958 Chinese college students (<i>M</i>_age = 18.68, ages 16-22, 78.2% were female) completed measures of the severity of COVID-19, long COVID somatic symptom, insomnia, fatigue, anxiety, and depressive symptoms. Four potential chain mediation models was used to examine the role of long COVID somatic symptoms, insomnia, and fatigue as mediators between COVID-19 and anxiety and depressive symptoms. The results showed that ∼80% of Chinese college students suffered COVID-19 in late 2022 and early 2023, and 47.8, 35.4, 43.8, 37, and 54.3% of the participants had at least one somatic symptom, insomnia, fatigue, anxiety, and depressive symptoms, respectively, about 2-3 months after onset. This study revealed that the influence of COVID-19 on anxiety and depressive symptoms is not determined by the severity of COVID-19 in acute phase but by long COVID. Long COVID somatic symptoms, insomnia, and fatigue played mediation effects in different degree between COVID-19 and anxiety and depressive symptoms. Interventions that target long COVID may improve anxiety and depressive symptoms of Chinese college students who have had COVID-19.