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01 June 2023: Clinical Research  

An Online Survey on the Relationship Between Positive Coping and Post-Traumatic Stress Symptoms (PTSS) of Medical Students in China During the COVID-19 Pandemic: The Mediating Role of Social Support

Hong-tao Song12ABCDEF*, Ling-ling Xia1EF, Yan Ma1B, Dongliang Jiao1B, Sihan Chen3B, Lijing Wang1B, Wenjuan Wang1B, Peipei Song1B, Linlin Mu1B, Li Li1B, Mengdie Pan1B, Lei Zhang1B, Jing Zhao1B, Jun-da Li1EF

DOI: 10.12659/MSM.939485

Med Sci Monit 2023; 29:e939485

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Abstract

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BACKGROUND: The COVID-19 pandemic has caused varying degrees of psychological stress among medical students. This research explored the post-traumatic stress symptoms (PTSS) of medical students in China and their relationship with positive coping and social support.

MATERIAL AND METHODS: In the form of cross-sectional online survey, 2280 medical students locked down at home were selected by random cluster method to investigate social support, coping style, and PTSS using the Social Support Rating Scale (SSRS), Simplified Coping Style Questionnaire (SCSQ), and Post-traumatic Stress Disorder (PTSD) Checklist-Civilian Version (PCL-C), respectively.

RESULTS: This research found that the PTSS detection rate in medical students was 10.42% during the COVID-19 pandemic. The PTSS scores of females were significantly higher than that of the males. However, the PTSS detection rate in females (9.71%) was not significantly different from that in males (11.24%). Compared with those of the non-PTSS group, the total score and its all-factor score of social support, the total score of coping style and the positive coping score of the PTSS group were much lower, while the negative coping score of the PTSS group was much higher (P<0.01). Positive coping was positively correlated with social support, while positive coping and social support were negatively correlated with PTSS. The total effect of positive coping on PTSS was -0.310 (P<0.001), the direct effect was -0.128 (P<0.01), and the indirect effect was -0.182 (P<0.001). Social support played a mediating role between positive coping and PTSS, with the mediating effect accounting for 58.81% of the total effect.

CONCLUSIONS: Social support plays a mediating role between positive coping and post-traumatic stress symptoms. Objective support and positive coping are the 2 main protective factors of PTSS.

Keywords: coping style, Post-Traumatic Stress Symptoms, Social Support, COVID-19, Medical Students, Male, Female, Humans, Stress Disorders, Post-Traumatic, COVID-19, Students, Medical, Cross-Sectional Studies, Pandemics, Adaptation, Psychological, Surveys and Questionnaires, China

Background

The novel coronavirus disease 2019 (COVID-19) has the characteristics of strong infectivity, sudden onset, and rapid progression [1,2]. Along with the increased number of new patients and lockdown at home, from front-line healthcare workers to the general public, many people were under varying degrees of psychological stress [3]. Relatively high rates of symptoms of anxiety (6.33% to 50.9%), depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) have been reported in the general population during the COVID-19 pandemic [4]. Compared with the general population, healthcare workers have a higher risk of psychological problems during the COVID-19 pandemic [5].

In addition to healthcare workers, college students, as another vulnerable group, are prone to mental health problems during the COVID-19 pandemic [6]. College students are in the transition phase from adolescence to adulthood, and their physical and mental development is still immature. A study shows that the incidences of anxiety, depression, and stressful negative moods among college students have been as high as 65.5%, 35.5%, and 10.95%, respectively, during the COVID-19 pandemic [7]. At the beginning of the pandemic, due to the lack of awareness of COVID-19, repeated media exposure to the COVID-19 pandemic may have improved the stress response of people [8]. Medical students, as prospective doctors with relevant professional backgrounds, have a higher awareness of epidemic information and more objectively interpret reports on COVID-19. During the COVID-19 pandemic, the levels of anxiety, depression, and stress of medical students were much lower than those of non-medical students in our previous research [9].

Exposure to the COVID-19 pandemic results in psychological trauma, which can lead to post-traumatic stress disorder (PTSD) in severe cases [10]. Meta-analysis shows that the prevalence rate of PTSD in severe COVID-19 patients is 16% [11], which was up to 21.5% among healthcare workers during the COVID-19 pandemic [12]. With improved awareness of the COVID-19 pandemic, the symptoms of anxiety, depression, fear, and other symptoms caused by the COVID-19 pandemic will gradually disappear, but post-traumatic stress disorder will continue for a long time [13]. A study showed that the cumulative proportion of patients with PTSD is 47.8% after the outbreak of severe acute respiratory syndrome (SARS), while 25.5% of patients still had PTSD 30 months after the SARS epidemic[14]. PTSD is a chronic mental illness with poor clinical treatment effects, which seriously affects mental health [15]. To improve people’s mental health and prevent PTSD caused by COVID-19, it is necessary to study the development and mechanism of PTSD.

In the field of stress research, it is generally believed that social support has the role of reducing stress and is the individual’s “available external resources” in the process of stress [16]. Social support can effectively reduce or alleviate stress intensity and protect individuals from the damage caused by COVID-19 [17]. Coping strategies and social support are 2 important factors that have affected mental health during the COVID-19 pandemic [18,19]. A study indicated that family support and coping strategies are closely related to mental health. Coping strategies play a mediating role between family support and mental health during the COVID-19 pandemic [20]. Research on patients with cured COVID-19 showed that emotional support was a protective factor against PTSD [21]. There are few research reports on the relationship between social support, coping style, and PTSS during the COVID-19 pandemic. According to current research, it is assumed that coping style, social support, and PTSS are related to each other, while social support plays a mediating role between coping style and PTSS.

During the COVID-19 pandemic, college students were isolated from each other and were on lockdown at home, and their psychological problems became more and more prominent [22]. To deal with the impact of COVID-19 on mental health, psychological rescue hotlines have been set up all over the world to actively carry out psychological rescue work. This current research sought to investigate the rate of PTSS in medical students during the COVID-19 pandemic. It also aimed to analyze the relationship among coping style, social support, and PTSS. The final purpose of this current research was to verify the mediating role of social support between coping style and PTSS to provide scientific methods to prevent PTSS.

Material and Methods

ETHICS CONSIDERATIONS:

This study was conducted anonymously. Informed consent was obtained before the study. The study received the approval from the Medical Research Ethics Committee of Bengbu Medical College (approval number 2022–2350).

STUDY DESIGN AND POPULATION:

A meta-analysis of mental problems in medical students during the COVID-19 pandemic reported that the prevalence of PTSD was 34% [23]. According to the sample size estimation formula N=t2(1-p)P/d2(p=0.34,d=0.1p,t=1.96), this study required at least 746 subjects with a 10% of margin error and 95% confidence interval. Using random cluster sampling, we selected 2280 medical students in lockdown at home. The following scales of were compiled into an electronic questionnaire powered by www.wjx.cn. The questionnaire had 52 items, including self-compiled demographic questionnaire, SSRS, SCSQ, and PCL-C. The pre-test of the questionnaire was conducted before the research. The items of the questionnaire met the survey needs. It would take about 10–15 minutes to complete the questionnaire. Data were collected from February 28, 2020 to March 5, 2020. The questionnaire was released through WeChat and QQ, and the subjects responded independently online through WeChat or QQ links. We excluded people with history of mental illness, organic diseases, and history of psychoactive substance abuse. To ensure the integrity and correctness of the data collection, all test questions were required to be answered completely. To prevent repeated answers, each IP address could only answer once. During the test, if the subjects had chosen the wrong option, they could go back and choose again. Informed consent was obtained from all subjects. To reassure the subjects, their names were not required. If the subjects wanted to, they could stop halfway. After answering the questionnaire, subjects could randomly select gifts as rewards. All questionnaires were recovered, with a recovery rate of 100%. We excluded 72 invalid questionnaires with incomplete answers, and 2208 valid samples were included, with an effective rate of 96.84% (Figure 1). The characteristics of the subjects are shown in Table 1.

STUDY INSTRUMENT:

The self-compiled demographic questionnaire was used to collect information about age, sex, only child status, education level, and place of residence.

The Simplified Coping Style Questionnaire (SCSQ) compiled by Folkman and Lararus was revised and tested by Xie Yaning [24,25]. SCSQ was used to investigate the coping style of medical students. It consists of positive and negative coping, including 20 items. Positive coping consisted of items 1 to 12, which mainly measured the characteristics of positive coping. In contrast, negative coping was made up of items 13 to 20, which mainly measured the characteristics of negative coping. The questionnaire was a self-rated scale with 4 grades. After each item of the coping style, there were 4 choices: not used, occasionally used, sometimes used, and often used (corresponding scores 0, 1, 2, 3). The subjects chose one of the answers according to their situation. The Cronbach’s α for SCSQ in the current study was 0.877, while the Cronbach’s α for positive coping and negative coping were 0.914 and 0.770, respectively.

The Social Support Rating Scale (SSRS) was compiled by Xiao Shuiyuan [26] and was used to investigate the social support of medical students. The SSRS consists of subjective support, objective support, and availability of support, including 10 items. Subjective support refers to the emotional experience and satisfaction of individuals being respected, supported, and understood in society, which is closely related to subjective feelings of individuals. Objective support refers to objective, visible, or practical support, including material direct assistance, social network, and the existence and participation of group relations. The degree of availability of support reflects the individual’s active use of all kinds of social support, including the way of talking, the way of asking for help, and the situation of participating in activities. The higher the score of SSRS, the better the social support. In 2008, Liu Jiwen tested the reliability and validity of the scale [27]. The Cronbach’s α for SSRS in the current study was 0.756.

The Post-traumatic Stress Disorder screening scale (PTSD Checklist-Civilian Version, PCL-C) was compiled by the Behavioral Science Division of the American Post-traumatic Stress Disorder Research Center according to DSM-IV [28]. The PCL-C was specially designed to evaluate the post-traumatic experience of ordinary people in normal life (as opposed to war). PCL-C investigated the post-traumatic stress symptoms of medical students. There are 17 items in the scale, and each item is divided into 5 grades: 1 “not at all”, 2 “a little”, 3 “moderate”, 4 “considerable”, and 5 “extreme”. The score was proportional to the occurrence of PTSD. The higher the score of PCL-C, the greater the possibility of PTSD. The reliability and validity of the scale were tested by Yang Xiaoyun [29]. It also has a high correlation with SCL-90 and EPQ, with good reliability and validity. The cut-off point of screening for PTSD is usually suggested to be set at 38 [30]. In this current research, 38 was used to screen for PTSS. The Cronbach’s α for PCL-C in the current study was 0.928.

STATISTICAL ANALYSES:

The database was established. SPSS 23.0 software was used for statistical analysis. Descriptive statistics were used to analyze the detection rates of PTSS in medical students. Chi-square analysis and Mann-Whitney U test were used to test the statistical difference between the PTSS group and the non-PTSS group. The relationship among coping style, social support, and PTSS was explored by Pearson correlation analysis. A structural equation model constructed by Amos17.0 was used to further verify whether social support played a mediating role between positive coping and PTSS. Stepwise forward logistic regression analysis (LR,λenter=0.05,λout=0.10) was performed to find the influencing factors of PTSS. In this current research, the two-sided t test was used and P<0.05 was used as the statistical significance test standard.

Results

STATUS OF POST-TRAUMATIC STRESS SYMPTOMS:

The median of PTSS was 24 (IQR,19–32), ranging from 17 to 85. According to the critical value of PCL-C in the screening for PTSS [30], 230 medical students had PTSS among 2208 medical students. The detection rate was 10.42%. Table 2 shows that during the COVID-19 pandemic, the severity of PTSS was different between males and females. The total PTSS score of females was much higher than that of males. The severity of PTSS did not have significant differences in the distribution of age, sex, only child status, education level, and place of residence.

THE SOCIAL SUPPORT, COPING STYLE STATUS, AND DEMOGRAPHIC CHARACTERISTICS OF THE PTSS GROUP AND NON-PTSS GROUP:

The PTSS detection rates in the distribution of age, sex, only child status, education level, and place of residence did not have significant differences (P>0.05). Compared with those of the non-PTSS group, the total score and its all-factor score of social support, the total score of coping style and the positive coping score of the PTSS group were much lower, while the negative coping score of the PTSS group was much higher (P<0.01) (Table 3).

ANALYSIS OF THE RELATIONSHIP BETWEEN COPING STYLE, SOCIAL SUPPORT, AND POST-TRAUMATIC STRESS SYMPTOMS:

Table 4 shows that during the COVID-19 pandemic, the coping style, positive coping, social support, and its all-factors were negatively correlated with PTSS (P<0.01). There was a significant positive correlation between negative coping and PTSS (P<0.01). Coping style and positive coping were positively correlated with social support and its all-factors (P<0.01), but there was no significant correlation between negative coping and social support and its all-factors (P>0.05).

PATH ANALYSIS OF THE RELATIONSHIP BETWEEN POSITIVE COPING, SOCIAL SUPPORT, AND POST-TRAUMATIC STRESS SYMPTOMS:

The positive coping of medical students was used as the manifest variable to measure positive coping, while objective support, subjective support, and availability of support were used as the latent variables to measure social support. The total score of post-traumatic stress symptoms was used as the manifest variable to measure PTSS. The analysis of the structural equation model was carried out using Amos17.0. Figure 2 (Amos17.0) indicates that the hypothetical model is appropriate and reasonable. Positive coping has a direct effect on social support and PTSS, while social support also has a direct effect on PTSS. It shows that positive coping can not only directly lead to PTSS, but can also lead to PTSS indirectly through social support. Social support plays a mediating role between positive coping and PTSS. Model fitting index: χ2=18.927, df=2, GFI=0.997, AGFI=0.974, NFI=0.988, RFI=0.940, IFI=0.989, TLI=0.946, CFI=0.989, RMSEA=0.062 (P<0.07).

ANALYSIS OF THE INTERMEDIARY EFFECT OF SOCIAL SUPPORT:

The bootstrap method was used to analyze the mediating effect of social support. Table 5 shows that the path differences in the model were statistically significant. The total effect of positive coping on post-traumatic stress disorder was −0.310 (95% CI: −0.346 to −0.271, P<0.001), the direct effect was −0.128(95% CI: −0.194 to −0.054, P<0.01), and the indirect effect was −0.182 (95% CI: −0.249 to −0.129, P <0.001). Therefore, the mediating effect of social support between positive coping and PTSS was 58.81% of the total effect.

THE INFLUENCING FACTORS OF PTSS:

Stepwise forward logistic regression analysis (LR,λenter=0.05, λout=0.10) was performed using the PTSS grouping (0 represents the non-PTSS group, 1 represents the PTSS group) as a dependent variable and age, sex, only child status, education level, place of residence, objective support, subjective support, availability of support, and positive coping as independent variables. The results show that only objective support and positive coping enter the logistic regression equation with PTSS as dependent variables (Hosmer-Lemeshow test, χ2=5.209, df=8, P=0.735), accounting for 7.4% and 3.6%, respectively. Objective support and positive coping are the 2 main protective factors of PTSS (Table 6).

Discussion

As a public health stress event, COVID-19 has seriously affected people’s mental health, causing problems such as anxiety, depression, and post-traumatic stress disorder [4]. During the COVID-19 pandemic, 34.9% of college students showed acute stress [31]. A large-sample study of Chinese college students in Guangdong Province during the epidemic reported that the incidence of stress symptoms among college students was 50.9% [32]. Another Chinese survey of adolescents during the COVID-19 pandemic found that the incidence of PTSS was 35.5% [33]. A meta-analysis of mental problems in medical students reported the prevalence of PTSD was 34% [23]. This current research found that during the COVID-19 pandemic, the PTSS detection rate in medical students was 10.42%. The prevalence of PTSS investigated in this current research is lower than that of other reported studies. The data of this current research were collected in the early stage of the COVID-19 outbreak. The time during which the participants had to be isolated at home was not very long. We found that the longer the isolation time, the higher the risk of post-traumatic stress disorder [34]. An investigation 1 month after the COVID-19 outbreak in China found that the incidence of PTSS was only 4.6% [35]. Therefore, the time at which an investigation was performed may be one of the reasons for inconsistent research results. Furthermore, the different scales used in the survey and the regional differences of the subjects may also have led to inconsistent results among studies.

This current research shows that during the COVID-19 pandemic, the severity of PTSS was different between males and females. The total PTSS score the females was much higher than that of the males. However, the PTSS detection rate in females (9.71%) was not significantly different from that in males (11.24%). A previous study has shown that there is a gender difference in the incidence of PTSS during the COVID-19 pandemic. The prevalence of PTSS in females is higher than that in males [36]. Interestingly, the prevalence rate of PTSD in healthcare professionals was also different by gender during the COVID-19 pandemic. One study showed that the prevalence of PTSD in female healthcare professionals (21.7%) is 4 times higher than that in males (5.1%) [37]. The gender difference in PTSS may be related to the greater psychological pressure to take care of the families for females [38]. It may also be that females lack coping skills in the face of epidemic pressure [39]. On the other hand, this gender difference of PTSS can be explained by genetic predisposition. Females are more likely to inherit factors related to anxiety [40]. There was no difference in the detection rate of PTSS in this current research, which may be related to the fact that medical students were isolated at home and did not show serious PTSS at the early stage of the COVID-19 pandemic. In addition to gender, mental illness is also a factor that increases the prevalence of PTSS. A study found that depression is significantly associated with PTSS. The incidence of PTSS in patients with depression during the epidemic was 16 times higher than that in normal controls [41].

We found that positive coping and social support were negatively correlated with PTSS. Social support and positive coping of the non-PTSS group were better than those of the PTSS group. Coping style is a conscious, purposeful, and flexible adjustment strategy for reality and environmental changes. If individuals are under high stress without positive coping, the risk of psychological problems can reach 43.3%, which is twice as high as that of the general population [42]. During the COVID-19 pandemic, the mental health of healthcare workers was positively correlated with positive coping and negatively correlated with negative coping [43]. Social support is defined as the influence that a person obtains through social contact, which can reduce psychological stress, relieve mental tension, and improve social adaptation. Lack of social support is a major risk factor for PTSD among healthcare workers during the COVID-19 pandemic [44]. In major traumatic events, a study has shown that the level and quality of social support are related to PTSD [45]. A study of post-traumatic stress disorder among rescue workers found that there is a negative correlation between social support and post-traumatic stress disorder, while social support plays an intermediary role in the effect of trait mindfulness on PTSD [46].

This current research also found that during the COVID-19 pandemic, social support and its all-factors of medical students were negatively correlated with PTSS. Family is the most important and main social support system for college students. Family disruption was related to maladaptation of children during the COVID-19 pandemic [47]. Family changes may be the main stressors that lead to PTSD. The lack of a social support system is an important cause of post-traumatic stress disorder among college students [48]. Healthcare workers with high social support had a low risk of PTSD [49]. Coping style and social support are the influencing factors for PTSS. The logistic regression analysis in this current research showed that objective support and positive coping were the 2 main protective factors for PTSS, accounting for 7.4% and 3.6%, respectively. Individuals with positive coping can get more social support, which may be an intermediary variable between positive coping and PTSS.

To clarify the relationship among positive coping, social support, and PTSS in medical students, structural equation models were constructed in this current research. The results showed that the lack of positive coping in medical students during the COVID-19 pandemic could lead to PTSS directly and indirectly through social support. Social support plays a mediating role between positive coping and PTSS. In earthquake disasters, the incidence of PTSD in people with high social support and high self-esteem is low. Social support can reduce the incidence of PTSD by improving self-esteem. There is a mediating effect on the level of self-esteem between social support and PTSD [50]. Thus, positive coping is conducive to seeking more social support resources to deal with stress. In the psychological rescue process, we can change the negative coping style of students to alleviate PTSS directly or indirectly through social support.

To the best of our knowledge, this current research is the first large-sample study on PTSS in medical students during the COVID-19 pandemic. It focused on the relationship among positive coping, social support, and PTSS. The mediating role of social support between positive coping and PTSS had been further clarified. The results of this current research will be used as scientific evidence to prevent PTSS. This current research also has some limitations. Social support played a mediating role between positive coping and PTSS, but this is only the result of the cross-sectional survey. The relationship between positive coping, social support, and PTSS needs to be verified by prospective research. Although the medical students in this study were all over China, some remote areas were not fully covered. Furthermore, an unbalanced distribution of gender, only child status, education level, and place of residence may be a deficiency of data collection in this current research. Our data need to be further expanded to be more representative. Although this current research used many control variables to prevent respondents from randomly answering the online questionnaires, some may not have responded truthfully due to concerns about disclosing personal privacy.

Conclusions

During the COVID-19 pandemic, the PTSS detection rate in medical students was 10.42%. The severity of PTSS was different between males and females. Positive coping was positively correlated with social support, while positive coping and social support were negatively correlated with PTSS. Social support plays a mediating role between positive coping and PTSS. Objective support and positive coping are the 2 main protective factors of PTSS. Our research suggests that we can change students’ negative coping style to alleviate PTSS directly or indirectly through social support in the process of psychological rescue.

References

1. Zhu N, Zhang D, Wang W, A novel coronavirus from patients with pneumonia in China, 2019: N Engl J Med, 2020; 382(8); 727-33

2. Chen N, Zhou M, Dong X, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study: Lancet, 2020; 395(10223); 507-13

3. Hossain MM, Tasnim S, Sultana A, Epidemiology of mental health problems in COVID-19: A review: F1000Res, 2020; 9; 636

4. Xiong J, Lipsitz O, Nasri F, Impact of COVID-19 pandemic on mental health in the general population: A systematic review: J Affect Disord, 2020; 277; 55-64

5. Uphoff EP, Lombardo C, Johnston G, Mental health among healthcare workers and other vulnerable groups during the COVID-19 pandemic and other coronavirus outbreaks: A rapid systematic review: PLoS One, 2021; 16(8); e0254821

6. Jia Q, Qu Y, Sun H, Mental health among medical students during COVID-19: A systematic review and meta-analysis: Front Psychol, 2022; 13; 846789

7. Han SS, Han YH, Tong WX, Chinese college students COVID-19 phobia and negative moods: Moderating effects of physical exercise behavior: Front Public Health, 2022; 10; 1046326

8. Garfin DR, Silver RC, Holman EA, The novel coronavirus (COVID-2019) outbreak: Amplification of public health consequences by media exposure: Health Psychol, 2020; 39(5); 355-57

9. Song HT, Ge CH, Chang LX, Investigation on the psychological status of college students during the coronavirus disease-2019 epidemic: J Gen Psychol, 2022; 149(4); 456-67

10. Chamaa F, Bahmad HF, Darwish B, PTSD in the COVID-19 Era: Curr Neuropharmacol, 2021; 19(12); 2164-79

11. Nagarajan R, Krishnamoorthy Y, Basavarachar V, Dakshinamoorthy R, Prevalence of post-traumatic stress disorder among survivors of severe COVID-19 infections: A systematic review and meta-analysis: J Affect Disord, 2022; 299; 52-59

12. Li Y, Scherer N, Felix L, Kuper H, Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis: PLoS One, 2021; 16(3); e0246454

13. Xiao S, Luo D, Xiao Y, Survivors of COVID-19 are at high risk of posttraumatic stress disorder: Glob Health Res Policy, 2020; 5; 29

14. Mak IW, Chu CM, Pan PC, Risk factors for chronic post-traumatic stress disorder (PTSD) in SARS survivors: Gen Hosp Psychiatry, 2010; 32(6); 590-98

15. Krediet E, Bostoen T, Breeksema J, Reviewing the potential of psychedelics for the treatment of PTSD: Int J Neuropsychopharmacol, 2020; 23(6); 385-400

16. Cassel J, The contribution of the social environment to host resistance: The Fourth Wade Hampton Frost Lecture: Am J Epidemiol, 1976; 104(2); 107-23

17. Szkody E, Stearns M, Stanhope L, Stress-buffering role of social support during COVID-19: Fam Process, 2021; 60(3); 1002-15

18. Dewa LH, Crandell C, Choong E, CCopeY: A mixed-methods coproduced study on the mental health status and coping strategies of young people during COVID-19 UK lockdown: J Adolesc Health, 2021; 68(4); 666-75

19. Guo K, Zhang X, Bai S, Assessing social support impact on depression, anxiety, and stress among undergraduate students in Shaanxi province during the COVID-19 pandemic of China: PLoS One, 2021; 16(7); e0253891

20. Yang C, Gao H, Li Y, Analyzing the role of family support, coping strategies and social support in improving the mental health of students: Evidence from post COVID-19: Front Psychol, 2022; 13; 1064898

21. Ju Y, Liu J, Ng RMK, Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge: Eur J Psychotraumatol, 2021; 12(1); 1915576

22. Birmingham WC, Wadsworth LL, Lassetter JH, COVID-19 lockdown: Impact on college students’ lives: J Am Coll Health, 2021 Online ahead of print

23. Peng P, Hao Y, Liu Y, The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis: J Affect Disord, 2023; 321; 167-81

24. Zeidner M, Endler NS: Handbook of coping, 1996; 107-31, John Wiley & Sons, Inc

25. Xie YN, A preliminary study on the reliability and validity of the simplified coping style scale: Chinese Journal of Clinical Psychology, 1998; 6(2); 114-15

26. Xiao SY, The theoretical basis and Research Application of Social support rating scale: Journal of Clinical Psychology Medicine, 1994; 4(2); 98-100

27. Liu JW, Li FY, Lian YL, Investigation of reliability and validity of the social support scale: Journal of XinJiang Medical University, 2008; 31(1); 1-3

28. Blanchard EB, Jones-Alexander J, Buckley TC, Psychometric properties of the PTSD Checklist (PCL): Behav Res Ther, 1996; 34(8); 669-73

29. Yang XY, Yang HA, Liu QG, The research on the reliability and validity of PCL-C and influence factors: China Journal of Heath Psychology, 2007; 15(1); 6-9

30. Lang AJ, Laffaye C, Satz LE, Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care: J Trauma Stress, 2003; 16(3); 257-64

31. Ma Z, Zhao J, Li Y, Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China: Epidemiol Psychiatr Sci, 2020; 29; e181

32. Li X, Lv S, Liu L, COVID-19 in Guangdong: Immediate perceptions and psychological impact on 304,167 college students: Front Psychol, 2020; 11; 2024

33. Ke S, Sun L, Zhou J, Factors influencing post-traumatic stress symptoms in Chinese adolescents during the COVID-19 pandemic: Front Psychiatry, 2022; 13; 892014

34. Dubey S, Biswas P, Ghosh R, Psychosocial impact of COVID-19: Diabetes Metab Syndr, 2020; 14(5); 779-88

35. Sun L, Sun Z, Wu L, Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China: MedRxiv, 2020; 2020; 20032425

36. Nzimande NP, El Tantawi M, Zuñiga RAA, Sex differences in the experience of COVID-19 post-traumatic stress symptoms by adults in South Africa: BMC Psychiatry, 2022; 22(1); 238

37. Blekas A, Voitsidis P, Athanasiadou M, COVID-19: PTSD symptoms in Greek health care professionals: Psychol Trauma, 2020; 12(7); 812-19

38. Clark S, McGrane A, Boyle N, “You’re a teacher you’re a mother, you’re a worker”: Gender inequality during COVID-19 in Ireland: Gender Work Org, 2021; 28(4); 1352-62

39. Tamres LK, Janicki D, Helgeson VS, Sex differences in coping behavior: A meta-analytic review and an examination of relative coping: Personal Soc Psychol Rev, 2002; 6(1); 2-30

40. Eisler RM, Skidmore JR, Masculine gender role stress: Scale development and component factors in the appraisal of stressful situations: Behav Modif, 1987; 11(2); 123-36

41. Peng M, Song X, Liu L, Comparison of prevalence and risk factors of PTSS between Chinese patients with depression and non-depressed controls during COVID-19 outbreak: Front Psychiatry, 2022; 12; 719931

42. Ray C, Lindop J, Gibson S, The concept of coping: Psychological Medicine, 1982; 12(2); 385-95

43. Xu Y, Zhao M, Tang XL, Correlation study between mental health and coping style of medical staff during COVID-19 epidemic: Anhui Medical Journal, 2020; 41(04); 368-71

44. Zhang H, Shi Y, Jing P, Posttraumatic stress disorder symptoms in healthcare workers after the peak of the COVID-19 outbreak: A survey of a large tertiary care hospital in Wuhan: Psychiatry Res, 2020; 294; 113541

45. Yuan G, Xu W, Liu Z, Resilience, posttraumatic stress symptoms, and posttraumatic growth in Chinese adolescents after a tornado: The role of mediation through perceived social support: J Nerv Ment Dis, 2018; 206(2); 130-35

46. Zhang Y, Fu G, Jiang HL, Relationship of mindfulness and post-traumatic stress disorder in professional rescue workers: The roles of intrusive rumination and social support: Chinese Journal of Clinical Psychology, 2019; 27(2); 311-15

47. Fosco GM, Sloan CJ, Fang S, Family vulnerability and disruption during the COVID-19 pandemic: prospective pathways to child maladjustment: J Child Psychol Psychiatry, 2022; 63(1); 47-57

48. Wang M, Qiao D, Analysis of the characteristics, causes and effects of PTSD in college students: Journal of Shaanxi Institute of Junior Managerial Personnel, 2019(2); 58-60

49. Zhu N, Zhang D, Wang W, A novel coronavirus from patients with pneumonia in China, 2019: N Engl J Med, 2020; 382(8); 727-33

50. Zhou X, Wu X, Zhen R, Self-esteem and hope mediate the relations between social support and post-traumatic stress disorder and growth in adolescents following the Ya’an earthquake: Anxiety Stress Coping, 2018; 31(1); 32-45

In Press

08 Feb 2024 : Clinical Research  

Serum Selenium Concentration as a Potential Diagnostic Marker for Early-Stage Colorectal Cancer: A Comparat...

Med Sci Monit In Press; DOI: 10.12659/MSM.942882  

09 Feb 2024 : Clinical Research  

Factors Influencing the Occurrence of Intraoperative Hypothermia in Patients Undergoing General Anesthesia ...

Med Sci Monit In Press; DOI: 10.12659/MSM.943463  

13 Feb 2024 : Clinical Research  

A Retrospective Study to Compare the Glasgow Coma Score, Pediatric Trauma Score, and Injury Severity Score ...

Med Sci Monit In Press; DOI: 10.12659/MSM.943501  

16 Feb 2024 : Clinical Research  

Etiology, Clinical Presentation, and Outcomes of Bacterial Meningitis in Adult Patients: A Retrospective St...

Med Sci Monit In Press; DOI: 10.12659/MSM.942904  

Most Viewed Current Articles

16 May 2023 : Clinical Research  

Electrophysiological Testing for an Auditory Processing Disorder and Reading Performance in 54 School Stude...

DOI :10.12659/MSM.940387

Med Sci Monit 2023; 29:e940387

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17 Jan 2024 : Review article  

Vaccination Guidelines for Pregnant Women: Addressing COVID-19 and the Omicron Variant

DOI :10.12659/MSM.942799

Med Sci Monit 2024; 30:e942799

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14 Dec 2022 : Clinical Research  

Prevalence and Variability of Allergen-Specific Immunoglobulin E in Patients with Elevated Tryptase Levels

DOI :10.12659/MSM.937990

Med Sci Monit 2022; 28:e937990

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01 Jan 2022 : Editorial  

Editorial: Current Status of Oral Antiviral Drug Treatments for SARS-CoV-2 Infection in Non-Hospitalized Pa...

DOI :10.12659/MSM.935952

Med Sci Monit 2022; 28:e935952

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750