{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:15:42Z","timestamp":1792192542496,"version":"4.4.0"},"reference-count":70,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"unspecified","delay-in-days":286,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2045796025100243_sec1a\">\n\t    <jats:title>Aims<\/jats:title>\n\t    <jats:p>The COVID-19 pandemic exacerbated psychological distress, but limited information is available on the shifts in mental health symptoms and their associated factors across different stages. This study was conducted to more reliably estimate shifts in mental health impacts and to identify factors associated with symptoms at different pandemic stages.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796025100243_sec2b\">\n\t    <jats:title>Methods<\/jats:title>\n\t    <jats:p>We performed a national repeated cross-sectional study at stable (2021), recurrence (2022), and end-of-emergency (2023) stages based on representative general national population with extensive geographic coverage. Anxiety, depression, post-traumatic stress disorder (PTSD) and insomnia symptoms were evaluated by GAD-7, PHQ-9, IES-R and ISI scales, respectively, and their associated factors were identified via multivariable linear regression.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796025100243_sec3c\">\n\t    <jats:title>Results<\/jats:title>\n\t    <jats:p>Generally, 42,000 individuals were recruited, and 36,218, 36,097 and 36,306 eligible participants were included at each stage. The prevalence of anxiety, depression and insomnia symptoms increased from 13.7\u201316.4% at stable to 17.3\u201322.2% at recurrence and decreased to 14.5\u201318.6% at end of emergency, while PTSD symptom continuously increased from 5.1% to 7.6% and 9.2%, respectively (all significant, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Common factors associated with mental health symptoms across all stages included centralized quarantine, frontline work and residence in initially widely infected areas. Centralized quarantine was linked to anxiety, depression, PTSD and insomnia during the stable, recurrence and end-of-emergency stages. Frontline workers exhibited higher risks of anxiety, depression and insomnia throughout these stages. Individuals in initially widely infected areas were more likely to experience depression and PTSD, particularly during the stable and recurrence stages. Stage-specific risk factors were also identified. Lack of outdoor activity was associated with anxiety, depression and insomnia during the stable and recurrence stages. Residents in high-risk areas during the recurrence stage correlated with increased anxiety and insomnia. Suspected infection was tied to anxiety and insomnia in the recurrence and end-of-emergency stages, while the death of family or friends was linked to PTSD during recurrence and to depression, PTSD and insomnia at the end-of-emergency stage.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2045796025100243_sec4d\">\n\t    <jats:title>Conclusions<\/jats:title>\n\t    <jats:p>Mental health symptoms increased when pandemic recurred, and could remain after end-of-emergency, requiring prolonged interventions. Several key factors associated with mental symptoms and their variations were identified at different pandemic stages, suggesting different at-risk populations.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/s2045796025100243","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T04:26:45Z","timestamp":1760416005000},"source":"Crossref","is-referenced-by-count":6,"title":["Mental health symptoms and associated factors for general population at the stable, recurrence, and end-of-emergency stages of the COVID-19 pandemic: a repeated national cross-sectional study"],"prefix":"10.1017","volume":"34","author":[{"given":"Shu","family":"Wang","sequence":"first","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Children\u2019s Hospital, Capital Medical University, National Center for Children\u2019s Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Ding","sequence":"additional","affiliation":[{"name":"Liaocheng People\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Meng","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Shandong First Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiting","family":"Hu","sequence":"additional","affiliation":[{"name":"Heze Mudan People\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuguang","family":"Guan","sequence":"additional","affiliation":[{"name":"SanBo Brain Hospital, Capital Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianwei","family":"Zeng","sequence":"additional","affiliation":[{"name":"Qilu Hospital of Shandong University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhua","family":"Liu","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fangang","family":"Meng","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University"},{"name":"Beijing Tiantan Hospital, Capital Medical University"},{"name":"Beijing Key Laboratory of Neurostimulation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minzhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Shandong Provincial Hospital Affiliated to Shandong First Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2266-6500","authenticated-orcid":false,"given":"Jianguo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Beijing Tiantan Hospital, Capital Medical University"},{"name":"Beijing Tiantan Hospital, Capital Medical University"},{"name":"Beijing Key Laboratory of Neurostimulation"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"S2045796025100243_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00251-0"},{"key":"S2045796025100243_ref2","first-page":"100916","article-title":"Sleep problems during COVID-19 pandemic and its\u2019 association to psychological distress: a systematic review and meta-analysis","volume":"36","author":"Alimoradi","year":"2021","journal-title":"Electronic Clinical Medicine"},{"key":"S2045796025100243_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00757-8"},{"key":"S2045796025100243_ref30","doi-asserted-by":"publisher","DOI":"10.1186\/s12985-021-01729-3"},{"key":"S2045796025100243_ref20","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ijbiomac.2022.01.118","article-title":"Three waves changes, new variant strains, and vaccination effect against COVID-19 pandemic","volume":"204","author":"El-Shabasy","year":"2022","journal-title":"International Journal of Biological Macromolecules"},{"key":"S2045796025100243_ref59","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-021-02046-4"},{"key":"S2045796025100243_ref62","unstructured":"World Health Organization (2023) World Health Organization 2023 data.who.int, WHO Coronavirus (COVID-19) dashboard &#x003E; Data [Dashboard]. 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