{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T01:05:23Z","timestamp":1790211923438,"version":"4.1.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000},"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 rapid spread of Coronavirus Disease-19 (COVID-19) infection has been the most important public health crisis across the globe since the end of 2019. Anxiety and depression are the most common mental health problems among people during the pandemic, and many studies have reported anxiety and depressive symptoms in college students. However, information on the mental health status of international medical students during this critical period of time has been scarce, which hinders the efforts in making proper policy or strategies to help these students. The present study aims to explore the prevalence of anxiety and depressive symptoms in international medical students in China and to find out the factors that have potential predictive value for anxiety and depressive symptoms.<\/jats:p><jats:p><jats:bold>Method:<\/jats:bold> A cross-sectional study was carried out for international medical students during November 2020 at China Medical University in Shenyang, China. Five hundred and nineteen international students were interviewed with questionnaires containing demographic variables, Stressors in school, Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Simplified Coping Style Questionnaire (SCSQ), Perceived Stress Scale (PSS-10), the Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R) and Resilience Scale-14 (RS-14). Univariate logistic regression and stepwise multiple logistic regression analyses were conducted where appropriate to explore the predictive factors of anxiety symptoms and depressive symptoms.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The prevalence of anxiety symptoms and depressive symptoms in the sample population was 28.5% (148\/519) and 31.6% (164\/519), respectively. Stressors in school (\u03b2 = 0.176, OR = 1.192, CI: 1.102\u20131.289), negative coping style (\u03b2 = 0.639, OR = 1.894, CI: 1.287\u20132.788) and perceived stress (\u03b2 = 0.230, OR = 1.258, CI: 1.184\u20131.337) were found to be the predictors of anxiety symptoms among the international medical students; while gender (\u03b2 = \u22120.594, OR = 0.552, CI: 0.315\u20130.968), stay up late (\u03b2 = 0.828, OR = 2.288, CI: 1.182\u20134.431), current place of residence (\u03b2 = 1.082, OR = 2.951, CI: 1.256\u20136.931), stressors in the school (\u03b2 = 0.303, OR = 1.354, CI: 1.266\u20131.496), negative coping style (\u03b2 = 0.866, OR = 2.377, CI: 1.516\u20133.725), perceived stress (\u03b2 = 0.233, OR = 1.262, CI: 1.180\u20131.351) were found to be predictors of depressive symptoms.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> The prevalence of anxiety symptoms and depressive symptoms was moderate among international medical students in China. The communal predictors of anxiety and depressive symptoms were stressors in school, negative coping style and perceived stress; while demographic factors such as gender (male), stay up late at night and current place of residence were found associated with depressive symptoms. These results suggest that proper stress management and specific interventions are needed to help students maintain their mental health during the COVID-19 pandemic period.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.761964","type":"journal-article","created":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T05:36:06Z","timestamp":1636004166000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Prevalence and Predictors of Anxiety and Depressive Symptoms Among International Medical Students in China During COVID-19 Pandemic"],"prefix":"10.3389","volume":"12","author":[{"given":"Lu-Lu","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue-Hang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Xi","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Qin","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo-Chen","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,4]]},"reference":[{"key":"B1","unstructured":"CSSEJHU\n          COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)2021"},{"key":"B2","unstructured":"WHO Announces COVID-19 Outbreak a Pandemic2020"},{"key":"B3","unstructured":"COVID-19 Governments' Measures: Report #1\u201319 March 20202020"},{"key":"B4","unstructured":"The Ministry of Education: The Use of Online Teaching: \u201cSuspending without Stopping\u201d"},{"key":"B5","unstructured":"Mental Health and COVID-192020"},{"key":"B6","doi-asserted-by":"publisher","first-page":"639955","DOI":"10.3389\/fpsyg.2021.639955","article-title":"Perceived stress and coping strategies among undergraduate health science students of Jimma University Amid the COVID-19 outbreak: online cross-sectional survey","volume":"12","author":"Awoke","year":"2021","journal-title":"Front Psychol."},{"key":"B7","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","volume":"301","author":"Deng","year":"2021","journal-title":"Psychiatry Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1017\/s2045796021000202","article-title":"Zhong BL. Prevalence of depressive symptoms among Chinese university students amid the COVID-19 pandemic: a systematic review and meta-analysis","volume":"30","author":"Luo","year":"2021","journal-title":"Epidemiol Psychiatric Sci."},{"key":"B9","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":"B10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s13033-019-0287-6","article-title":"Prevalence and predictors of depression and anxiety among medical students in Addis Ababa, Ethiopia","volume":"13","author":"Kebede","year":"2019","journal-title":"Int J Ment Health Syst."},{"key":"B11","doi-asserted-by":"publisher","first-page":"853","DOI":"10.2147\/amep.s278841","article-title":"Odokonyero R. Prevalence and factors associated with depression among medical students at Makerere University, Uganda","volume":"11","author":"Olum","year":"2020","journal-title":"Adv. Med. Educ. Pract."},{"key":"B12","doi-asserted-by":"publisher","first-page":"4956234","DOI":"10.1155\/2020\/4956234","article-title":"Perceived stress, depression, and associated factors among undergraduate health science students at Arsi University in 2019 in Oromia, Ethiopia","volume":"2020","author":"Worku","year":"2020","journal-title":"Psychiatry Journal"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e2025591","DOI":"10.1001\/jamanetworkopen.2020.25591","article-title":"Factors associated with mental health disorders among university students in France confined during the COVID-19 pandemic","volume":"3","author":"Wathelet","year":"2020","journal-title":"JAMA Netw Open."},{"key":"B14","doi-asserted-by":"publisher","first-page":"355","DOI":"10.3760\/cma.j.cn116021-20200903-00440","article-title":"Investigation on mental health status of overseas medical students during the COVID-19 epidemic","volume":"20","author":"Cheng","year":"2021","journal-title":"Chin J Med Educ Res."},{"key":"B15","doi-asserted-by":"publisher","first-page":"187","DOI":"10.2147\/amep.s95820","article-title":"Evaluation of preceptors and skills achievement by clinical pharmacy clerkship students during their clinical rotations at University of Gondar, Ethiopia","volume":"7","author":"Belachew","year":"2016","journal-title":"Adv Med Educ Pract."},{"key":"B16","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1097\/phm.0000000000001491","article-title":"A required, combined neurology-physical medicine and rehabilitation clerkship addresses clinical and health systems knowledge gaps for fourth-year medical students","volume":"100","author":"Curtis","year":"2021","journal-title":"Am J Phys Med Rehab."},{"key":"B17","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1037\/\/0022-3514.50.3.571","article-title":"Appraisal, coping, health status, and psychological symptoms","volume":"50","author":"Folkman","year":"1986","journal-title":"J Pers Soc Psychol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"108305","DOI":"10.1016\/j.jsat.2021.108305","article-title":"The investigation of the mediating role of coping trategies on the relationship between childhood traumas, depression and alcohol use disorder in university students","volume":"123","author":"Akcan","year":"2021","journal-title":"J Subst Abuse Treat."},{"key":"B19","doi-asserted-by":"publisher","first-page":"383","DOI":"10.31729\/jnma.4911","article-title":"Perceived stress and stressors among medical and dental students of Bhairhawa, Nepal: a descriptive cross-sectional study","volume":"58","author":"Bali","year":"2020","journal-title":"JNMA J Nepal Med Assoc."},{"key":"B20","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12909-018-1133-2","article-title":"Perceived stress, reasons for and sources of stress among medical students at Rabigh Medical College, King Abdulaziz University, Jeddah, Saudi Arabia","volume":"18","author":"Gazzaz","year":"2018","journal-title":"BMC Med Educ."},{"key":"B21","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3390\/bs8080070","article-title":"Depressed as freshmen, stressed as seniors: the relationship between depression, perceived stress and academic results among medical students","volume":"8","author":"Iorga","year":"2018","journal-title":"Behav Sci."},{"key":"B22","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1177\/001440299606200504","article-title":"Social relationships of students with exceptionalities in mainstream classrooms: social networks and homophily","volume":"62","author":"Farmer","year":"1996","journal-title":"Except Child."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1037\/\/0022-3514.67.6.1063","article-title":"Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test","volume":"67","author":"Scheier","year":"1994","journal-title":"J Pers Soc Psychol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1002\/jclp.10020","article-title":"The metatheory of resilience and resiliency","volume":"58","author":"Richardson","year":"2002","journal-title":"J Clin Psychol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/j.cpr.2009.11.004","article-title":"Emotion-regulation strategies across psychopathology: a meta-analytic review","volume":"30","author":"Aldao","year":"2010","journal-title":"Clin Psychol Rev."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07448481.2020.1842424","article-title":"The impact of COVID-19 on college anxiety, optimism, gratitude, and course satisfaction","volume":"2020","author":"Biber","year":"2020","journal-title":"J ACH"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/00221309.2020.1835800","article-title":"Resilience effects on student performance and well-being: the role of self-efficacy, self-set goals, and anxiety","volume":"2020","author":"Etherton","year":"2020","journal-title":"J General Psychol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1080\/10401334.2016.1146611","article-title":"Resilience among medical students: the role of coping style and social support","volume":"28","author":"Thompson","year":"2016","journal-title":"Teach Learn Med."},{"key":"B29","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":"B30","first-page":"310","volume-title":"Handbook of Common Psychological Assessment Scales","author":"Dai","year":"2010"},{"key":"B31","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":"B32","volume-title":"Handbook of Rating Scales in Psychiatry","author":"Zhang","year":"2015"},{"key":"B33","first-page":"114","article-title":"Reliability and validity of Simplified Coping Style Questionnaire","volume":"6","author":"Xie","year":"1998","journal-title":"Chin J Clin Psychol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s40359-020-00444-y","article-title":"Psychological resilience and positive coping styles among Chinese undergraduate students: a cross-sectional study","volume":"8","author":"Wu","year":"2020","journal-title":"BMC Psychol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1186\/s12888-020-02826-3","article-title":"Coping style, social support and psychological distress in the general Chinese population in the early stages of the COVID-19 epidemic","volume":"20","author":"Yu","year":"2020","journal-title":"BMC Psychiatry"},{"key":"B36","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav."},{"key":"B37","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12888-017-1221-6","article-title":"The Vietnamese version of the Perceived Stress Scale (PSS-10): translation equivalence and psychometric properties among older women","volume":"17","author":"Dao-Tran","year":"2017","journal-title":"BMC Psychiatry"},{"key":"B38","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1080\/00223891.1990.9674095","article-title":"Psychometric characteristics of the Multidimensional Scale of Perceived Social Support","volume":"55","author":"Zimet","year":"1990","journal-title":"J Pers Assess."},{"key":"B39","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1002\/1097-4679(199111)47:6<756::aid-jclp2270470605>3.0.co;2-l","article-title":"The multidimensional scale of perceived social support: a confirmation study","volume":"47","author":"Dahlem","year":"1991","journal-title":"J Clin Psychol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"e0229958","DOI":"10.1371\/journal.pone.0229958","article-title":"Chang PC. Multidimensional Scale of Perceived Social Support in Indonesian adolescent disaster survivors: a psychometric evaluation","volume":"15","author":"Laksmita","year":"2020","journal-title":"PLoS ONE"},{"key":"B41","first-page":"165","article-title":"Development and psychometric evaluation of the Resilience Scale","volume":"1","author":"Wagnild","year":"1993","journal-title":"J Nurs Meas."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1007\/s00520-012-1699-x","article-title":"Validation of the Chinese version of the resilience scale and its cutoff score for detecting low resilience in Chinese cancer patients","volume":"21","author":"Tian","year":"2013","journal-title":"Support Care Cancer."},{"key":"B43","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1186\/s12885-019-5679-0","article-title":"Resilience and associated factors among Chinese patients diagnosed with oral cancer","volume":"19","author":"Gao","year":"2019","journal-title":"BMC Cancer."},{"key":"B44","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1097\/01.psy.0000127692.23278.a9","article-title":"What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models","volume":"66","author":"Babyak","year":"2004","journal-title":"Psychosom Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.neubiorev.2021.03.024","article-title":"Anxiety, depression, trauma-related, and sleep disorders among healthcare workers during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"126","author":"Marvaldi","year":"2021","journal-title":"Neurosci Biobehav Rev."},{"key":"B46","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1007\/s10597-020-00659-8","article-title":"Acculturative stress among female Saudi college students in the United States","volume":"57","author":"Al-Krenawi","year":"2021","journal-title":"Community Ment Health J."},{"key":"B47","doi-asserted-by":"publisher","first-page":"354","DOI":"10.4103\/0971-5916.156571","article-title":"Stress, anxiety and depression among medical undergraduate students and their socio-demographic correlates","volume":"141","author":"Iqbal","year":"2015","journal-title":"Indian J Med Res."},{"key":"B48","first-page":"840","article-title":"Frequency and perceived causes of depression, anxiety and stress among medical students of a private medical institute in Karachi: a mixed method study","volume":"69","author":"Azim","year":"2019","journal-title":"JPMA."},{"key":"B49","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jad.2021.05.028","article-title":"Association between perceived stress and depression among medical students during the outbreak of COVID-19: the mediating role of insomnia","volume":"292","author":"Liu","year":"2021","journal-title":"J Affect Disord."},{"key":"B50","doi-asserted-by":"publisher","first-page":"e0154729","DOI":"10.1371\/journal.pone.0154729","article-title":"The associations of psychological stress with depressive and anxiety symptoms among Chinese Bladder and renal cancer patients: the mediating role of resilience","volume":"11","author":"Li","year":"2016","journal-title":"PLoS ONE."},{"key":"B51","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12888-020-02796-6","article-title":"Prevalence and predictors of anxiety and depressive symptoms among patients diagnosed with oral cancer in China: a cross-sectional study","volume":"20","author":"Yuan","year":"2020","journal-title":"BMC Psychiatry."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/07448481.2021.1891086","article-title":"University students under lockdown, the psychosocial effects and coping strategies during COVID-19 pandemic: a cross sectional study in Egypt","volume":"2021","author":"El-Monshed","year":"2021","journal-title":"J Am College Health"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1912","DOI":"10.1016\/j.addbeh.2012.12.005","article-title":"Relations among stress, coping strategies, coping motives, alcohol consumption and related problems: a mediated moderation model","volume":"38","author":"Corbin","year":"2013","journal-title":"Addict Behav."},{"key":"B54","doi-asserted-by":"publisher","first-page":"588578","DOI":"10.3389\/fpubh.2020.588578","article-title":"Depressive symptoms, sleep quality and diet during the 2019 novel coronavirus epidemic in China: a survey of medical students","volume":"8","author":"Xie","year":"2020","journal-title":"Front Public Health."},{"key":"B55","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.jad.2017.04.021","article-title":"The relationship between chronotype and depressive symptoms: a meta-analysis","volume":"218","author":"Au","year":"2017","journal-title":"J Affect Disord."},{"key":"B56","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1080\/07420528.2020.1865393","article-title":"The association between chronotype and suicidality among students of the medicine and psychology faculties\u2014the mediating role of general mental health indices","volume":"38","author":"Mokros","year":"2021","journal-title":"Chronobiol Int."},{"key":"B57","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.psychres.2018.08.046","article-title":"Chronotype and suicide: the mediating effect of depressive symptoms","volume":"269","author":"Park","year":"2018","journal-title":"Psychiatry Res."},{"key":"B58","doi-asserted-by":"publisher","first-page":"e044236","DOI":"10.1136\/bmjopen-2020-044236","article-title":"Depression and its correlation with social support and health-promoting lifestyles among Chinese university students: a cross-sectional study","volume":"11","author":"Tang","year":"2021","journal-title":"BMJ Open."},{"key":"B59","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1002\/ijop.12586","article-title":"Homesickness in social context: an ecological momentary assessment study among 1st-year university students","volume":"55","author":"Nauta","year":"2020","journal-title":"Int J Psychol."},{"key":"B60","doi-asserted-by":"publisher","first-page":"377","DOI":"10.7655\/NYDXBSS20140508","article-title":"Investigation and research on mental health of International students in Nanjing","volume":"14","author":"Wang","year":"2014","journal-title":"Acta Univ Med Nanjing (Social Sciences)"},{"key":"B61","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s40359-021-00598-3","article-title":"Impact of COVID-19 on the mental health of US college students","volume":"9","author":"Lee","year":"2021","journal-title":"BMC Psycholy."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.761964\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T05:36:17Z","timestamp":1636004177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.761964\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,4]]},"references-count":61,"alternative-id":["10.3389\/fpsyt.2021.761964"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.761964","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,4]]},"article-number":"761964"}}