Echoes of Strain: A Two-Year Longitudinal Study on the Impact of China's Zero-COVID Policy on College Students' Insomnia and Depressive Symptoms

Purpose: In China, stringent and long-lasting infection control measures, which were called "dynamic zero-COVID policy", have significantly affected the mental health of college students, particularly concerning depressive and insomnia symptoms. This study aims to investigate how depressive and insomnia symptoms evolved among Chinese college students throughout the pandemic, including the beginning and end of the dynamic zero-COVID policy period.

Patients and methods: We conducted a 2-years longitudinal survey involving 1102 college students, collecting data at three key time points. Depressive symptoms were assessed using the Patient Health Questionnaire-9, and insomnia symptoms were measured with the Youth Self-rating Insomnia Scale-8. Three contemporaneous symptom networks and two cross-lagged panel networks were constructed.

Results: In the current sample, the prevalence of clinically significant depressive symptoms was 6.1%, 8.9%, and 7.7% during the first, second, and third waves, respectively. The prevalence of clinically significant insomnia symptoms was 8.1%, 13.0%, and 14.1%. Over time, the severity of depressive and insomnia symptoms and network density increased, persisting at least one year after the pandemic and control measures ended. "Difficulty initiating sleep" bridged the two disorders, while "anhedonia" played a pivotal role in triggering and sustaining other symptoms.

Conclusion: This study underscores the lasting impact of the evolving zero-COVID policy on depressive and insomnia symptoms among college students, elucidating the underlying interaction mechanisms. There is a pressing need for a more comprehensive evaluation of the implementation of restrictive public policies, taking into account their potential long-term consequences.