College Student Anxiety Evaluated Following China’s Sudden COVID-19 Policy Reversal

A cross-sectional investigation conducted among 858 university students in Southwest China revealed that 16.08 percent of respondents experienced clinically significant anxiety and 29.14 percent experienced event-related psychological distress following the sudden transition of national COVID-19 prevention and control strategies. When considering varying symptom severity, 47.2 percent of participants exhibited measurable levels of psychological anxiety, while 65.9 percent reported mild to moderate distress triggered directly by the policy shift. The survey, administered across fifteen institutions between December 2022 and January 2023, captured student mental health during an unprecedented public health pivot. Moderate psychological anxiety was recorded in 10.6 percent of the student cohort, with an additional 3.8 percent reporting moderate to severe or severe anxiety levels. Concurrently, moderate and severe event-related psychological impacts were documented among 29.1 percent of surveyed individuals. By focusing on this abrupt transitional window, the research documented how the rapid alteration of epidemic control measures generated notable psychological burdens across a major postsecondary student population.

The policy backdrop for the study involved the promulgation of the open strategy, officially designated as the Ten New Measures, by the Chinese Center for Disease Control and Prevention on December 7, 2022. Under this revised regulatory framework, compulsory isolation protocols for individuals diagnosed with SARS-CoV-2 infection were terminated, the systematic tracking and identification of close contacts ceased, and the administrative delineation of high-risk and low-risk zones was discontinued. This systemic shift rapidly transformed higher education environments into focal settings for accelerated viral transmission as postsecondary institutions managed the emerging epidemiological dynamics. The immediate cessation of stringent non-pharmaceutical interventions prompted a sharp escalation in confirmed infection numbers across academic campuses. While public health authorities sought to normalize social functioning, the sudden dismantlement of institutional barriers prompted widespread concern regarding secondary infections, long-term disease sequelae, and localized surges in transmission, establishing a stressful environment for students navigating changing health and administrative expectations.

Researchers noted that while numerous prior investigations had assessed the psychological impacts of COVID-19 among university cohorts during earlier pandemic phases, those initial analyses were contextualized by rigorous containment, lockdowns, and campus closures. Earlier literature had documented anxiety symptom prevalences of 24.9 percent in China, 29.8 percent in Malaysia, and 38.5 percent in the United States under strict quarantine regimens. However, the investigators emphasized that empirical observations from containment periods could not be directly generalized to an abrupt strategy reversal from comprehensive containment to full liberalization. The sudden policy transition generated unique environmental stressors characterized by immediate transmission surges within densely settled campus communities, the loss of relied-upon institutional safeguards such as mandatory diagnostic testing and centralized quarantine, and concurrent shortages of basic antipyretic medications and antigen detection kits. These distinct post-liberalization circumstances created acute vulnerabilities, necessitating dedicated investigation into how rapid strategic deregulation altered psychological outcomes among emerging adult student populations.

To capture these perishable mental health dynamics, the research team implemented a cross-sectional study design from December 17, 2022, to January 17, 2023, during which participating universities suspended in-person instruction and transitioned to online teaching. Participant recruitment was executed across fifteen colleges and universities throughout Southwest China utilizing snowball sampling via the Questionnaire Star digital platform, supplemented by social media and electronic mail outreach. The minimum required sample size was statistically calculated as 564 participants using the standard formulation based on an expected anxiety prevalence of 31 percent, a precision margin of 4 percent, a 95 percent confidence interval, and an anticipated 10 percent nonresponse rate. Study eligibility required active enrollment across junior college, undergraduate, master’s, or doctoral programs and voluntary electronic informed consent. Individuals with recorded histories of mental illness, those absent or suspended from university administration, and those declining participation were excluded. The study protocol secured ethical approval from Southwest Medical University’s Biomedical Ethics Committee under registration number SWMUIRBKS-202212-0011.

The self-administered digital survey instrument incorporated validated psychometric scales alongside sociodemographic and epidemic-specific assessments. Generalized anxiety was evaluated using the Generalized Anxiety Disorder-7 scale, which demonstrated exceptional internal reliability in this cohort with a Cronbach’s alpha coefficient of 0.95. The instrument presents seven self-report items scored from zero to three, generating cumulative scores ranging between 0 and 21. Standard clinical thresholds categorized scores into normal mental health from 0 to 4, mild anxiety from 5 to 9, moderate anxiety from 10 to 13, moderate to severe anxiety from 14 to 18, and severe anxiety from 19 to 21, with scores of 10 or greater defining significant anxiety. Event-related psychological distress was measured using the Impact of Event Scale-Revised, which exhibited a Cronbach’s alpha coefficient of 0.96. The scale evaluated intrusion, avoidance, and hyperarousal dimensions; following study scoring protocols, intrusion and avoidance subscales were summed to generate a 0 to 64 classification score, where scores of 26 or higher designated distress.

Demographic profiles of the 858 participating students showed that 70.6 percent were female, 77.5 percent were aged between 17 and 22 years, 75.4 percent were pursuing bachelor’s degrees, and 81.8 percent were enrolled in medical majors. Regarding household finances, 36.0 percent reported monthly family incomes below 446 United States dollars, 34.3 percent reported earnings between 446 and 892 dollars, and 37.4 percent had relatives employed within healthcare fields. The overall mean score on the Generalized Anxiety Disorder-7 was 4.93 with a standard deviation of 4.78, with 52.8 percent demonstrating normal mental health, 31.2 percent mild anxiety, 10.6 percent moderate anxiety, and 1.6 percent severe anxiety. On the Impact of Event Scale-Revised, the cohort averaged 16.73 with a standard deviation of 13.17; specifically, 34.1 percent exhibited no stress reactions, 36.8 percent displayed mild stress, 26.8 percent demonstrated moderate stress, and 2.3 percent manifested severe stress responses to the policy shift.

The survey also assessed student perceptions and non-pharmaceutical behavioral modifications implemented following the deregulation announcement. Overall, 93.2 percent of respondents reported awareness of the strategic shift, and 57.5 percent believed the policy would exert a beneficial influence on their academic studies and personal daily lives. Nevertheless, acute systemic concerns remained prominent, as more than 90 percent of students linked the open strategy to extensive viral outbreaks, 92.5 percent anticipated an immediate surge in infection rates, and 86.2 percent perceived an emerging deficit in clinical medical resources. In response to heightened infection hazards, students adopted variable protective practices. The three most frequently reported preventive measures comprised frequent hand washing at 75.4 percent, consistent mask wearing at 73.0 percent, and maintaining a one-meter social distance at 61.7 percent. Conversely, only 5.6 percent implemented no precautions, while fewer than half reported prudent antibiotic use, avoidance of handshakes, or prophylactic consumption of traditional Chinese herbal preparations.

Statistical analyses conducted using SPSS software version 26.0 identified significant associations through chi-square tests and binary logistic regression models, maintaining multicollinearity thresholds below a variance inflation factor of 10. In univariate chi-square analyses, significant correlations with anxiety emerged for age, education level, vaccination status, self-assessed health status, chronic disease history, and COVID-19 knowledge level. In multivariate logistic regression modeling using forward stepwise selection with an entry threshold of P less than 0.05, incomplete vaccination status remained strongly associated with elevated anxiety, with unvaccinated or incompletely vaccinated students being 2.45 times more likely to experience anxiety compared to fully vaccinated peers (odds ratio 2.45, 95 percent confidence interval 1.381 to 4.362, P equals 0.002). Poor self-assessed health independently predicted anxiety (odds ratio 2.84, 95 percent confidence interval 1.289 to 6.243, P equals 0.01). Conversely, students without chronic illnesses demonstrated significantly lower odds of anxiety (odds ratio 0.42, 95 percent confidence interval 0.249 to 0.705, P equals 0.001).

Multivariate regression modeling for event-related psychological distress identified older age, incomplete vaccination, and lower disease knowledge as independent associated factors. Students aged 23 to 25 demonstrated greater susceptibility to distress compared to those aged 17 to 22 years (odds ratio 2.22, 95 percent confidence interval 1.014 to 4.873, P equals 0.046). The authors linked this pattern to graduating students facing cumulative pressures involving degree requirements, professional internships, and challenging employment environments during policy deregulation. Incomplete vaccination also elevated distress probability (odds ratio 1.68, 95 percent confidence interval 1.009 to 2.803, P equals 0.046), reflecting heightened personal vulnerability regarding SARS-CoV-2 infection. Furthermore, lower COVID-19 knowledge scores, assessed via a seven-item metric referencing official diagnostic guidelines, increased distress likelihood (odds ratio 1.46, 95 percent confidence interval 1.028 to 2.072, P equals 0.034). Researchers suggested that after three years of pandemic disruptions, distress was driven by event-related trauma and information deficits regarding viral risks rather than acute panic.

The investigators outlined explicit methodological limitations alongside structural recommendations for academic institutions navigating future public health emergencies. Methodologically, the reliance on snowball sampling prevented true randomization and introduced potential selection bias. Furthermore, participant recruitment was restricted exclusively to universities in Southwest China, limiting geographic generalizability across diverse economic and administrative regions. The sample also featured a pronounced overrepresentation of female participants at 70.6 percent and medical undergraduates at 81.8 percent, cohorts whose baseline health awareness and psychological coping styles may differ from general student bodies. Self-reported questionnaires additionally carried risks of recall inaccuracies and social desirability bias. In response to these findings, the authors recommended that university administrators establish age-sensitive psychological counseling, conduct proactive health screenings to support students managing chronic illnesses with timely medical supplies, reframe vaccination through clear communication campaigns as a psychological resilience mechanism, and adopt phased transition protocols rather than abrupt policy terminations during emerging infectious disease outbreaks.

Subject of Research: Mental health impacts and psychological distress among university students following pandemic policy transitions

Article Title: Anxiety levels among college students following the sudden transition of prevention and control strategies against COVID-19

Article References: Hu, C., Jiang, W., Yang, Y., Yang, X., Tang, Z., Tian, L., & Xu, Y. (2026). Anxiety levels among college students following the sudden transition of prevention and control strategies against COVID-19. Discover Public Health, 23(1), Article 1764. https://doi.org/10.1186/s12982-026-03275-1

Image Credits: AI Generated

DOI: 10.1186/s12982-026-03275-1

Keywords: COVID-19, mental health, college students, anxiety, psychological distress, public health policy, epidemiology, cross-sectional study, levels, college, students, following