Mental Health Among College Students During the COVID-19 Pandemic in China: A 2-Wave Longitudinal Survey

•In this large-scale longitudinal epidemiologic assessment of a cohort of college students in China, the prevalence of acute stress symptoms decreased, while the rates of depressive and anxiety symptoms increased over the course of the epidemic.•Around 10% of students had persistent and/or developed new mental health problems. Multiple factors, including senior students, COVID-19 exposure, COVID-19-related worries, social support, and family function were significant predictors of distinct mental health trajectories.•Mental health concerns significantly increased over the course of the epidemic, clinicians and academic administrations alike should pay close attention to college students’ expressed needs and associated risk factors for trajectories of psychopathology. Growing evidence supports a clear association between COVID-19 pandemic and mental health. However, little is known about the longitudinal course of psychopathology in young adults at different stages of the pandemic. This large-scale, longitudinal, population-based survey was conducted among college students in China. The rates of three mental health problems (acute stress, anxiety, and depressive symptoms), and their change patterns at two phases of the pandemic (early vs under-control) were measured. Predictors of changes in mental health symptoms were examined utilizing multivariate regression. Among the 164,101 college students who participated in the first wave survey (T1=during onset of outbreak), 68,685 (41.9%) completed a follow-up survey (T2=during remission). In the follow-up survey, the prevalence of probable acute stress (T1: 34.6%; T2: 16.4%) decreased, while the rates of depressive (T1: 21.6%; T2: 26.3%) and anxiety symptoms (T1: 11.4%; T2: 14.7%) increased. Senior students, with suspected or conformed cases in their community and COVID-19 related worries (all AORs > 1.20, ps < 0.001) were found to have a higher risk of developing mental health problems in at least one wave. Less physical exercise, low perceived social support, and a dysfunctional family were found to negatively impact psychological symptoms. Acute stress, anxiety, and depressive symptoms have been prevalent among college students during the COVID-19 epidemic, and showed a significant increase after the initial stage of the outbreak. Some college students, especially those with the risk factors noted above, exhibited persistent or delayed symptoms.