LAUSR

Background The outbreak of COVID-19 has been a big challenge for senior high school students in China who are facing tremendous pressure of the highly competitive College Entrance Examination. Methods To evaluate the psychological impact of the event in the population, we conducted an anonymous online survey among senior high school students in China between 26 Feb and 4 March, 2020. Information collected included demographic characteristics, attitude toward medical study, infection of COVID-19 in acquaintances, anxiety symptoms evaluated using the GAD-7, and health literacy level measured using the IDSHL. Results Of 21,085 participants, 3,575 (17.0%), 943 (4.5%) and 448 (2.1%) reported with mild, moderate, and severe anxiety. Female, higher academic year, worse self-evaluated academic performance, negative attitude toward medical study, living in Hubei province and having acquaintance infected with COVID-19 were significantly associated with anxiety level, while higher education level of mother and higher IDSHL score were associated with a lower risk. The score of IDSHL, particularly of the domain “infectious disease prevention”, was associated with the GAD-7 score in a linear pattern (β=-0.0371, p<0.01). Limitations Limitations included the cross-sectional study design unable to infer the casual relationship, anonymous survey, selection bias and self-reported anxiety disorder levels. Conclusions The results suggested that COVID-19 outbreak may increase anxiety level in senior high school students in China. The anxiety related factors observed in this study may help to identify vulnerable individuals and develop interventions.