{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:47:23Z","timestamp":1791499643548,"version":"4.3.4"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:00:00Z","timestamp":1621814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> The coronavirus disease\u22122019 (COVID-19) pandemic has halted in-person medical education worldwide. Limited studies have reported on the mental health status of medical students during this public health emergency. This study aimed to explore the association of personal virus exposure, regional epidemic condition, and social support with medical students' depressive and anxiety symptoms during the COVID-19 outbreak in China.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> In February 2020, 5,982 medical students (60.0% females, Mean<jats:sub>age<\/jats:sub> = 21.7 years, Median<jats:sub>age<\/jats:sub> = 22 years) completed an online survey consisting of demographics, personal virus exposure, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The prevalence rates of mild to severe depressive symptoms and anxiety symptoms were 35.2 and 22.8%, respectively. Multivariate linear regression showed that students with low- or medium-level social support had a higher risk of experiencing depressive or anxiety symptoms than those with high-level social support. COVID-19 exposure was positively associated with mild to severe depressive or anxiety symptoms. Respondents living in provinces with 500\u20131,000 confirmed COVID-19 cases had an increased risk of experiencing mild to severe depressive symptoms compared with those living in provinces with &amp;lt;100 cases. Other related factors were gender and years of training.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Some medical students suffered from a poor psychological status during the COVID-19 outbreak. Low social support was a stronger factor related to poor mental status compared with COVID-19 exposure or the provincial epidemic condition. Thus, we suggest that colleges or universities provide social support and mental health screening.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.555893","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T04:45:27Z","timestamp":1621831527000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":35,"title":["The Association Between Social Support, COVID-19 Exposure, and Medical Students' Mental Health"],"prefix":"10.3389","volume":"12","author":[{"given":"Yi","family":"Yin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingjie","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suoyuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingxu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1186\/s12909-020-02267-2","article-title":"What is the impact of the COVID-19 pandemic on emergency medicine residency training: an observational study","volume":"20","author":"Lo","year":"2020","journal-title":"BMC Med Educ"},{"key":"B2","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s12909-020-02462-1","article-title":"Effects of the COVID-19 pandemic on medical students: a multicenter quantitative study","volume":"21","author":"Harries","year":"2021","journal-title":"BMC Med Educ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1001\/jama.2016.17324","article-title":"Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis","volume":"316","author":"Rotenstein","year":"2016","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1111\/medu.13770","article-title":"Prevalence of depressive symptoms among medical students: overview of systematic reviews","volume":"53","author":"Tam","year":"2019","journal-title":"Med Educ"},{"key":"B5","doi-asserted-by":"publisher","first-page":"456","DOI":"10.1111\/medu.12962","article-title":"Prevalence of depression amongst medical students: a meta-analysis","volume":"50","author":"Puthran","year":"2016","journal-title":"Med Educ"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2735","DOI":"10.3390\/ijerph16152735","article-title":"The global prevalence of anxiety among medical students: a meta-analysis","volume":"16","author":"Quek","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12909-015-0425-z","article-title":"Depression and stress amongst undergraduate medical students","volume":"15","author":"Ludwig","year":"2015","journal-title":"BMC Med Educ"},{"key":"B8","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s12909-016-0791-1","article-title":"Factors associated to depression and anxiety in medical students: a multicenter study","volume":"16","author":"Brenneisen Mayer","year":"2016","journal-title":"BMC Med Educ"},{"key":"B9","doi-asserted-by":"publisher","first-page":"113863","DOI":"10.1016\/j.psychres.2021.113863","article-title":"The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: a systematic review and meta-analysis","author":"Deng","year":"2021","journal-title":"Psychiatry Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"113298","DOI":"10.1016\/j.psychres.2020.113298","article-title":"University students' changes in mental health status and determinants of behavior during the COVID-19 lockdown in Greece","volume":"292","author":"Patsali","year":"2020","journal-title":"Psychiatry Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"434464","DOI":"10.3389\/fpsyt.2021.634464","article-title":"Impulsivity mediates associations between problematic internet use, anxiety, and depressive symptoms in students: a cross-sectional COVID-19 study","volume":"12","author":"Gecaite-Stonciene","year":"2021","journal-title":"Front Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e23126","DOI":"10.2196\/23126","article-title":"Geographic distribution of mental health problems among Chinese college students during COVID-19 pandemic: cross-sectional, online survey study","volume":"23","author":"Wu","year":"2021","journal-title":"J Med Internet Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"110219","DOI":"10.1016\/j.jpsychores.2020.110219","article-title":"Mental health status and change in living rhythms among college students in China during the COVID-19 pandemic: a large-scale survey","volume":"137","author":"Chen","year":"2020","journal-title":"J Psychosom Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/smi.1116","article-title":"Anxiety among university students during the SARS epidemic in Hong Kong","volume":"23","author":"Wong","year":"2007","journal-title":"Stress Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/j.jiph.2020.01.005","article-title":"Middle East respiratory syndrome-corona virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia","volume":"13","author":"Al-Rabiaah","year":"2020","journal-title":"J Infect Public Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"5047","DOI":"10.3390\/ijerph17145047","article-title":"Social distancing among medical students during the 2019 coronavirus disease pandemic in China: Disease awareness, anxiety disorder, depression, and behavioral activities","volume":"17","author":"Xiao","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"152202","DOI":"10.1016\/j.comppsych.2020.152202","article-title":"The mental state and risk factors of Chinese medical staff and medical students in early stages of the COVID-19 epidemic","volume":"102","author":"Wu","year":"2020","journal-title":"Compr Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0033291720001555","article-title":"Psychological distress among health professional students during the COVID-19 outbreak","author":"Li","year":"2020","journal-title":"Psychol Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"2395","DOI":"10.2147\/RMHP.S273333","article-title":"Increased levels of anxiety among medical and non-medical university students during the COVID-19 pandemic in the united Arab emirates","volume":"13","author":"Saddik","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"B20","doi-asserted-by":"publisher","first-page":"105912","DOI":"10.1016\/j.childyouth.2020.105912","article-title":"Immediate psychological responses during the initial period of the COVID-19 pandemic among Bangladeshi medical students","volume":"122","author":"Safa","year":"2021","journal-title":"Child Youth Serv Rev"},{"key":"B21","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.amsu.2020.11.025","article-title":"The psychological impact of COVID-19 on medical education of final year students in Pakistan: a cross-sectional study","volume":"60","author":"Dhahri","year":"2020","journal-title":"Ann Med Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1146\/annurev-publhealth-032013-182435","article-title":"Mental health consequences of disasters","volume":"35","author":"Goldmann","year":"2014","journal-title":"Annu Rev Public Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1001\/jama.2020.5227","article-title":"Medical student education in the time of COVID-19","volume":"323","author":"Rose","year":"2020","journal-title":"JAMA."},{"key":"B24","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/j.jad.2020.11.109","article-title":"Mental health among college students during the COVID-19 pandemic in China: a 2-wave longitudinal survey","volume":"281","author":"Li","year":"2021","journal-title":"J Affect Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1016\/j.jadohealth.2020.07.001","article-title":"The effect of social support on mental health in Chinese adolescents during the outbreak of COVID-19","volume":"67","author":"Qi","year":"2020","journal-title":"J Adolesc Health"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.wombi.2020.12.014","article-title":"Perceived social support and prenatal wellbeing; the mediating effects of loneliness and repetitive negative thinking on anxiety and depression during the COVID-19 pandemic","author":"Harrison","year":"2021","journal-title":"Women Birth"},{"key":"B27","doi-asserted-by":"publisher","first-page":"4479","DOI":"10.3390\/ijerph17124479","article-title":"COVID-19-related factors associated with sleep disturbance and suicidal thoughts among the Taiwanese public: a Facebook survey","volume":"17","author":"Li","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B28","unstructured":"Press Conference of the Joint Prevention and Control Mechanism of the State Council2020"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"B30","unstructured":"Coronavirus Disease 2019 (COVID-19) Situation Report-252020"},{"key":"B31","unstructured":"2019nCoV Virus Epidemic Situation2020"},{"key":"B32","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1111\/appy.12266","article-title":"Validity study of patient health questionnaire-9 items for internet screening in depression among Chinese university students","volume":"9","author":"Du","year":"2017","journal-title":"Asia Pac Psychiatry"},{"key":"B34","doi-asserted-by":"publisher","first-page":"112934","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The psychological impact of the COVID-19 epidemic on college students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3969\/j.issn.1002-0829.2010.04.002","article-title":"Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients","volume":"22","author":"He","year":"2010","journal-title":"Shanghai Arch Psychiatry"},{"key":"B37","first-page":"127","article-title":"Social support rating scale","author":"Xiao","year":"1999","journal-title":"Chin Ment Health J."},{"key":"B38","doi-asserted-by":"publisher","first-page":"408","DOI":"10.3969\/j.issn.1000-6729.2020.5.005","article-title":"Relations of suicides and suicide attempts to social support and quality of life in rural China","volume":"34","author":"Liu","year":"2020","journal-title":"Chin Ment Health J"},{"key":"B39","doi-asserted-by":"publisher","first-page":"3385","DOI":"10.1002\/sim.2771","article-title":"Sample size determination for logistic regression revisited","volume":"26","author":"Demidenko","year":"2007","journal-title":"Stat Med"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e15337","DOI":"10.1097\/MD.0000000000015337","article-title":"Prevalence of mental health problems among medical students in China: a meta-analysis","volume":"98","author":"Zeng","year":"2019","journal-title":"Medicine."},{"key":"B41","unstructured":"WangX\n          WHO Expert Speaks Out on China's Epidemic Response: China Daily2020"},{"key":"B42","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/1471-244X-10-104","article-title":"Psychological response of family members of patients hospitalised for influenza A\/H1N1 in oaxaca, Mexico","volume":"10","author":"Elizarraras-Rivas","year":"2010","journal-title":"BMC Psychiatry"},{"key":"B43","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1016\/S2215-0366(20)30491-0","article-title":"The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts","volume":"8","author":"Pan","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"B44","doi-asserted-by":"publisher","first-page":"e0228152","DOI":"10.1371\/journal.pone.0228152","article-title":"The relationship between psychological health and social support: evidence from physicians in China","volume":"15","author":"Sun","year":"2020","journal-title":"PLoS ONE"},{"key":"B45","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1002\/chp.20096","article-title":"Resilience training for hospital workers in anticipation of an influenza pandemic","volume":"31","author":"Aiello","year":"2011","journal-title":"J Contin Educ Health Prof"},{"key":"B46","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/j.anr.2017.08.005","article-title":"Exploring nursing intention, stress, and professionalism in response to infectious disease emergencies: the experience of local public hospital nurses during the 2015 Mers outbreak in South Korea","volume":"11","author":"Oh","year":"2017","journal-title":"Asian Nurs Res."},{"key":"B47","first-page":"69","volume-title":"China Health Statistics Yearbook","year":"2019"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.555893\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T04:45:32Z","timestamp":1621831532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.555893\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,24]]},"references-count":47,"alternative-id":["10.3389\/fpsyt.2021.555893"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.555893","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,24]]},"article-number":"555893"}}