Psychological Resilience of Chinese College Students: A Cross-Sectional Study after the Deblocking of China’s COVID-19 Pandemic Strategy

Psychological resilience (PR) plays an important role in fortifying mental health during pandemics. This study aimed to examine the PR and its related factors of college students in China after the deblocking of the China’s COVID-19 pandemic strategy. A total of 1100 college students from 15 universities participated in this cross-sectional survey by multi-stage stratified sampling. Data were collected by self-designed socio-demographic information, the family function assessment scale (APGAR), a general health questionnaire (GHQ-12), the general self-efficacy scale (GSES), and a psychological resilience scale. The average score of PR was 135.65 ± 18.54. Cluster analysis of PR scores showed that 24.9% of the college students had weak PR. The higher PR, the higher mental health status (r = 0.352, p < 0.05). Females had higher PR than males (OR = 0.550, 95% CI: 0.367–0.827). High self-efficacy was an independent protective factor of high PR (OR = 0.093, 95% CI: 0.059–0.145). Low family contact frequency, poor family function, and bad mental health status were the independent risk factors of high PR. In conclusion, the PR of Chinese college students were insufficient after the deblocking of China’s COVID-19 pandemic strategy, indicating an improvement of PR should be put into practice immediately. Frequent monthly contact with family, family function, self-efficacy, mental health status, and gender were the influencing factors of PR, which provides an intervention strategy for the future.


Introduction
Psychological resilience (PR) is a multidimensional concept, which refers to "the relative resistance to environmental risk experience or the overcoming of adversity" [1], such as a pandemic.PR highlights the good adaptation of individuals after experiencing major difficulties or trauma.The process of forming PR can be roughly divided into three steps: (1) individuals experience adversity or stress, and discover the protective factors of PR or the quality of overcoming adversity; (2) individuals possess these PR qualities or protective factors through their own integration; and (3) individuals gain experience and recover from interference or adversity [2].Studies have shown that the PR varied from each of the individuals [3,4].In addition, the level of individual PR is not fixed [1].On one hand, although individual PR can be cultivated through some steps, different individuals face different risk environments; on the other hand, the individual makes different responses when facing risks at different ages and in different environments.A study showed that the PR is the core element of well-being [5], which is very important to prevent and alleviate mental health problems [6].At the same time, PR is regarded as one of the key abilities of higher educational graduates in the 21st century [7].
During the COVID-19 global health pandemic, calls have been made to address the associated public health crisis, including public mental health.Since December 2019, China's epidemic prevention and control program used isolation at home and mask wearing as the core methods to reduce the spread of the virus between persons [8,9].The measure of isolation at home caused great changes in the lives of college students [10].During the 3-year-lockdown period in China, many studies have suggested that the rates of anxiety and depression during the epidemic were higher than in ordinary conditions [11][12][13][14][15].
Based on the ability of coping with adversity [16], PR has been discussed in previous studies.From the perspective of positive psychology, higher PR helps students get rid of negative emotions faster and adapt better [17].Firstly, some previous studies on college students' PR mostly studied the relationship between single factors and PR.For example, military training may play a positive role in improving Freshmen's PR and reducing depressive symptoms; the scores of patients' Health Questionnaire-9 (PHQ-9) decreased significantly [18].Secondly, many researchers study the PR of college students focused on their different characteristics.For example, some researchers pointed out that college students diagnosed with ADHD (Attention-deficit hyperactivity disorder) may represent a particularly resilient group [19].Additionally, other studies take PR as an intermediate factor to explore whether it has an impact and the size of its impact.For instance, during the COVID-19 pandemic, a study on the impact of college students' stress and anxiety on their sleep showed that the enhancement of PR weakens the relationship between perceived stress and anxiety regarding sleep quality [20].
On the 7th of December 2022, China announced it would end its 3-year COVID-19 lockdown strategy.Although the above research has provided important clues in the mechanism of PR, to date, few studies have looked specifically at the mechanism of the PR of college students as the outcome variable, especially after the deblocking of China's COVID-19 pandemic strategy.
On the 3rd of January 2023, the World Health Organization's (WHO's) Director General concurred with the advice offered by the Committee regarding the ongoing COVID-19 pandemic and determined that the event continues to constitute a public health emergency of international concern (PHEIC) [21].Thus, considering the dynamic process of PR, it is a serious and important affair to understand the situation of the PR among the college students after the deblocking of China's COVID-19 pandemic strategy, indicating that there is a need to study this phenomenon.Meanwhile, in order to understand PR fully, based on previous studies, we intend to investigate more factors related to PR such as family, general self-efficacy, and mental health status [16][17][18][19][20].
While evidence about the effects of PR on COVID-19 is emerging, the trajectories of PR remain unknown, especially after the deblocking of China's COVID-19 pandemic strategy.Identifying more influencing factors may contribute to better PR and sharing experiences and information, which is of utmost importance.Therefore, since PR is a protective factor of mental health, from the perspective of positive psychology this study aims to explore PR and its related factors among Chinese college students after the deblocking of China's COVID-19 pandemic strategy, by considering the role that PR has played in bolstering mental health status during the COVID-19 pandemic, and in building positive processes and capacities that may help individuals cope with and grow through the pandemic.

Study Population and Procedures
This was a cross-sectional study conducted in five regions (Beijing, Guangxi, Hunan, Hainan, and Xizang) of China in late December 2022, when China announced the deblocking of its COVID-19 pandemic strategy.Sample size was calculated using the formula for cross-sectional studies: α = 0.05, n = u α/2 2 P(1 − P)/d 2 ("P" refers to the estimated proportion and "d" stands for the error), where u = 1.96 when α = 0.05.By the multi-stage stratified cluster sampling, a total of 1100 college students from 15 universities participated in the questionnaire survey, with an efficiency rate of 98.0% (1078/1100).
During this survey, the investigation is both through a paper form and electronic form of the questionnaire.In the Hunan province, we used the paper form of the questionnaire for students who were willing to participate in this study, the paper form questionnaires were distributed and retrieved by our trained investigators; for other districts, the electronic form of the questionnaire was preferred, which was emailed to participants by our trained investigators.

Socio-Demographic Information
This study uses a self-designed questionnaire to collect the socio-demographic information of participants, including gender, age, nationality, family residence, grade, family economic level, average monthly living expenses in school, monthly contact frequency with family, the education level of parents, and parents' marital status.

Family Function Survey
The Adaptation-Partnership-Growth-Affection-Resolve Questionnaire (APGAR), compiled by Smilkstein of the University of Washington, is mainly used to evaluate an individual's family function, including five items: adaptability, cooperation, growth, emotion, and intimacy [22].Each question has 3 options, of which "rarely" to "often" are scored 0-2 points, respectively.The total score is 0-3, indicating a serious impairment of family function, 4-6 indicating a moderate impairment of family function, and 7-10 indicating a good family function.The higher the score, the better the family function.Studies have shown that the questionnaire has good reliability and validity, and has good internal consistency reliability in the Chinese population (Cronbach's α = 0.91) [23].

Mental Health Status
The 12-item general health questionnaire (GHQ-12) was used to evaluate the mental health status of the respondents in recent weeks [24].GHQ-12 can be widely used in the epidemiological investigation of mental disorders and the screening of mental disorders in the community population.At the same time, it can be used as a reliable and effective tool to measure the mental health status of Chinese college students.According to the scoring method recommended by the WHO, the GHQ-12 uses a binary scoring method, which means that 0 or 1 point is calculated for each question.The positive responses non pathologic (e.g., "feeling good", "as usual") are scored as 1, and the negative pathologic responses (e.g., "feeling bad", "negative evaluation") are scored as 0. The total score is within the range of 0-12 points.The higher the score, the lower the level of mental health.The higher the score, the greater the possibility of mental disorder.Studies at home and abroad generally believe that the best cut-off value of GHQ-12 score is 3 points.GHQ screening positive means that the total score is higher than or equal to 3 points, and negative means the total score is less than 3 points.Evidence shows that GHQ-12 has good reliability and validity in the Chinese population, and the Cronbach's α is 0.75 [25].

General Self-Efficacy
The general self-efficacy scale (GSES), compiled by German professor Ralf Schwarzer, is mainly used to evaluate self-efficacy [26].The scale adopts Likert's 4-point scoring (1 = completely incorrect, 4 = completely correct), and the total score is 10-40 points.The higher the total score, the higher the self-efficacy of the subjects.Some scholars have shown that the scale has good reliability and validity, and has good internal consistency reliability among college students in China (Cronbach's α = 0.92) [27].

Psychological Resilience
In this study, the Resilience Scale of College Students compiled by Liu Lanlan of Hebei Normal University was used to evaluate the PR of the respondents [28].The scale is composed of eight dimensions: social communication ability, family support, friend support, optimistic and tolerant attitude, self-worth, self recognition, self-control, and self adjustment.It includes 38 items, including 8 reverse scoring items: 5-level scoring, 1 point for complete nonconformity, 2 points for comparative nonconformity, 3 points for uncertainty, 4 points for comparative conformity, and 5 points for complete conformity.Reverse scoring items are scored forward.The higher the score, the better the state of resilience.The total scale has good reliability and validity (Cronbach's α = 0.91).However, because the Resilience Scale used in this study does not provide a reference boundary value of resilience classification, this study combines the resilience classification and hierarchical cluster analysis results obtained by previous researchers [9,28,29], and takes the psychological resilience score as the clustering index for k-means cluster analysis.The samples are divided into three categories: strong resilience, intermediate resilience, and weak resilience.

Statistical Analysis
The statistical software SPSS 24.0 (IBM Corp., Armonk, NY, USA) was used to conduct statistical analysis.Descriptive analyses were analyzed by mean ± standard deviation (χ ± s, the mean is represented by χ, the standard deviation is represented by s), frequency, and rate.The χ 2 test and t test were used to compare the differences of PR status among college students with different characteristics.The Mantel-Haenszel χ 2 (ordered categorical form variables) and the Pearson Correlation Coefficient (continuous form variables) were performed to conduct the correlation analyses.The ordered logistic regression analysis was conducted to explore the influencing factors of PR among college students in China with the odds ratio (OR) and its 95% confidence interval (CI).The test level α is 0.05.

The Characteristics of the Study Population
Among the respondents, men accounted for 35.1% (378/1078) and women accounted for 64.9% (700/1078).The average age of the participants was 20.26 (±1.25) years.Participants of Han nationality accounted for 87.6% (944/1078); 56.8% (612/1078) of them lived in urban areas; 91.7% (989/1078) of their parents were in a stable marriage, whose degrees of education were mainly junior high school or high school; 61.0% (658/1078) of the participants had a medium family economic level; 78.3% (844/1078) of the respondents had an average monthly living expense of more than 1000 yuan/month; 56.6% (610/1078) of them had a good family function; and 59.6% (642/1078) of them were in contact with family more than 5 times a month.

Psychological Resilience of College Students in China
The average score of PR of college students in China was (135.65 ± 18.543), which varied from 70 to 188.Among them, 268 (24.9%) had low PR, 516 (47.9%) had intermediate PR, and 294 (27.3%) had high PR.Among the eight dimensions of PR, "family support" scored the highest (26.77 ± 4.662), while "self-control" scored the lowest (10.27 ± 2.211).(See Table 1 for specific results).Among the 1078 respondents, the average score of the family function survey was 6.99 ± 2.572, the highest score was 10 and the lowest was 0. Among them, 112 had severe family dysfunction, 356 had moderate family dysfunction, and 610 had good family function, accounting for 10.4%, 33.0%, and 56.6%, respectively.The average score for individuals with severe family function disorders is 2.29 ± 0.889, the average score for individuals with moderate family function disorders is 5.13 ± 0.732, and the average score for individuals with good family function is 8.93 ± 1.168.Among the five dimensions, "degree of cooperation" scored the lowest (1.22 ± 0.739) and "degree of growth" scored the highest (1.58 ± 0.588).See Table 2 for detailed results (Table 2).
The average score of mental health status was 2.16 ± 2.377, with a highest score of 12 and a lowest score of 0. In the mental health status survey, there were 324 positive respondents and 754 negative respondents, accounting for 30.1% and 69.9%, respectively.The average score of positive respondents and negative respondents was 5.17 ± 2.125 and 0.87 ± 0.753, respectively (Table 3).
The average score of the self-efficacy survey was 25.01 ± 5.375, with a highest score of 40 and a lowest score of 12. See Table 3 for specific results.Additionally, the distribution of PR among students with different gender, family economic status, monthly contact frequency with family, family function, and mental health status were significant (p < 0.05).The results are shown in Tables 4 and 5.

Correlations Analysis of Psychological Resilience
Results showed that the PR was positive, which significantly correlated with family function and self-efficacy, however, the PR was negative, which significantly correlated with family contact frequency, mental health, and family economic level (p < 0.01) (Table 6).

Influencing Factors of PR among College Students in China
Taking PR as the dependent variable, the ordered logistic regression analysis method was conducted.Gender, family economic status, monthly contact frequency with family, family function, mental health, father's education level, mother's education level, parents' marital status, and monthly living expenses were taken as independent variables, and the scores of self-efficacy were used as a covariate for regression analysis.Results showed that monthly contact frequency with family, family function, self-efficacy score, mental health status, and gender were the influencing factors of PR.The independent protective factors for the reduction of high PR are being a woman (OR = 0.550, 95% CI = (0.367, 0.827)) and a high sense of efficacy (OR = 0.093, 95% CI = (0.059, 0.145)).The independent risk factors of high PR were low family contact frequency, poor family function, and unhealthy mental health.The PR of college students with contact 2-4 times per month with their family (OR = 1.600, 95% CI = (1.078,2.377)) or contact frequency ≤1 time (OR = 3.053, 95% CI = (1.041,8.953)), moderate impairment of family function (OR = 3.114, 95% CI = (2.024,4.797)) or severe family dysfunction (OR= 11.858, 95% CI = (5.680,24.730)), and unhealthy mental state (OR = 3.633, 95% CI = (2.237,5.906)) was low.Additionally, considering the gender, we conducted the stratified analysis according to gender.The results of stratified analysis according to gender showed that the PR of males was impacted by independent variables such as monthly contact with family, family function, mental health and selfefficacy.However, the PR of females was impacted by independent variables such as family function, mental health, and self-efficacy.See Tables 7 and 8 for detailed results.After the deblocking of China's COVID-19 pandemic strategy, only 27.3% of Chinese college students had high PR during COVID-19, while 24.9% of the students had low PR, indicating that the PR of Chinese college students should be improved.Compared to previous studies during the COVID-19 pandemic in China, the PR level of college students after the deblocking of China's COVID-19 pandemic strategy were similar to that reported in such studies [9,29].Zeng et al. [9] investigated an independent college in Guangdong province in 2020 by using the Psychological Resilience Scale proposed by Hu and Gan (five-point Likert scale), the score of PR was 3.417 ± 0.443; and in our previous investigation conducted in the Hunan province in 2021 by using the Chinese version of the Resilience Scale for College Students (RSCS), constructed by Liu, the PR of college students was 137.97 ± 15.50, which is close to the median, indicating that the participants' PR was at a medium level [29].However, the PRs of this study were lower than students in some other countries.Sarmiento et al. reported that 57.7% of the university students in Spain presented high resilience [30]; Surzykiewicz et al. found that the resilience in the Polish population during the COVID-19 period were 18.64 ± 5.28 (ranging from 0-30) [31].
PR is varied in different regions, populations, and individuals.As previous studies reported, the framework of PR has both internal and external factors [32], and adversity is an important factor in the concept of PR [33].Internal factors of PR include biological and psychological factors, such as gender, physical condition, intelligence, and so on.External factors include family, society, countries, peer group, isolation measures, etc.However, the stress and adversity are obviously non-randomly distributed among individuals [1].So, the enhancement of PR lies not in avoiding stress, but in how people deal with life changes and how they act in the face of adversity [34].According to the Coping with COVID-19 with Resilience (COPERS) study initiated by the international Public Mental Health Section of the European Public Health Association (EUPHA), it is important to identify the PR trajectories of adults aged 18 years and older and to detect factors that potentially influence their PR in the different countries [35].The premise of improving college students' PR is to understand the protective or risk factors related to PR.In this study, these factors are mainly personal factors and family environmental factors, which is consistent with previous research.The results of ordered logistic regression analysis showed that the independent protective factors for the reduction of high PR include a high sense of efficacy, and the independent risk factors of high PR were weak self-confidence, low frequency of family contact, poor family function, and unhealthy mental health, and females are likely to have higher PR than males. (

1) PR and self-efficacy
There was a positive correlation between self-efficacy and PR among Chinese college students after the deblocking of China's COVID-19 pandemic strategy.The stronger the individual's self-efficacy, the higher the level of PR, which is consistent with other research [36][37][38][39][40][41].As previous studies reported, the correlation between PR and self-efficacy is quite high.For example, if individuals do not have a sense of self-efficacy, they will lack sufficient motivation to persist in difficulties or adversity, and it will be difficult to produce resilience [38].In a study on nurses' academic burnout, it is pointed out that there is a significant relationship between PR and self-efficacy, and students with a higher PR score higher in academic efficacy.The higher the general self-efficacy of college students, the more likely they are to adopt optimistic and positive thinking and behavior in coping with adversity [40].Some researchers explained the reasons for the above conclusions as follows: self-efficacy is an important factor of PR, and a high level of self-efficacy can be used as a stress buffer to improve PR [41].
(2) PR and mental health After the deblocking of China's COVID-19 pandemic strategy, the PR of Chinese college students is positively correlated with mental health, which indicates a predictive effect of resilience to mental health.The higher the level of resilience, the better the state of mental health.A domestic study on whether college students have left behind experience points out that mental health status problems are negatively correlated with resilience [42].Foreign scholars have also pointed out that resilience is negatively correlated with mental health status problems such as pain, depression, anxiety, unhappiness, and other domains [43][44][45].In adversity, compared with young people with lower resilience, young people with higher resilience are less likely to have mental health status problems and can better cope with adversity [46].Thus, some frustration with education and training could be added to the work of mental health status promotion among students.
(3) PR and monthly contact with family and family function Related to the COVID-19 pandemic, this is the first study to give evidence of the two factors (monthly contact with family, family function) having a positive impact on the PR.The family provides a key support for individuals: the more actively parents encourage, the more they can make their children focus on their career goals [47]; the warmer family members felt, the easier it is to help individuals cultivate confidence in overcoming difficulties and the ability to adapt to the environment [48]; and the existence of a family connection provides protection for the students [34], such as financial assistance, advice when children are confused, etc. [49].The reason for this phenomenon may be related to the children's attachment to their parents.The higher the degree of parent-child attachment, the lower the level of social interaction anxiety and the higher the psychological resilience [50].
(4) PR and gender After the deblocking of China's COVID-19 pandemic strategy, results from this study show that the PR score of females was higher than that of males, while research of medical students showed that the PR score of female medical students was lower than that of male medical students [51].As for the opposite results, Rutter once explained that females seem to be less vulnerable than males when facing psychosocial adversity, and women are less likely to cause destructive behavior in others [34].However, Hirani and Hegadoren hold a different opinion and gave a detailed explanation, they pointed out that although women's scores on resilience indicators are generally lower than those of men, the existing concept of resilience does not reflect gender roles and differently shapes the experiences of women and men and their responses to adversity [52].And, according to the results of the stratified analysis by gender in this study, the PR of females and males were independently affected by monthly contact with family, family function, mental health, and self-efficacy.However, for female students, the PR of females was independently affected by family function, mental health and self-efficacy.Only the factor of monthly contact with family was different among female and male students, which might be caused by the contact habit differences between females and males.Therefore, more research about the resilience among different genders should be explored.
Basing on the above findings, consistent with previous studies [30,31], socio-demographic variables have no significant way to build resilience during the COVID-19 pandemic.However, this study found that the importance of family support (monthly contact with family and family function) as a protective factor against anxiety, loneliness, fear, and other negative feelings experienced during college life during the COVID-19 pandemic.Therefore, schools and families should pay more attention to family support for students.Situations similar to the COVID-19 pandemic may occur in the future, and intervention strategies should be put in place to meet the family support required.Additionally, some intervention measures should be put in practice to tackle the absence of family support.More research is needed to study effective ways to improve and maintain a good psychological resilience.
However, there are some limitations to this study and our results should be interpreted with caution.First of all, this study is limited by its cross-sectional analysis, thus the causal relationships cannot be obtained.Secondly, all data are from the questionnaire survey, which is easily affected by the mood and living environment of the subjects during this investigation, so the data can only reflect the feelings of the respondents in the period before the survey.Thirdly, the respondent biases were unavoidable as a result of the self-reported design.Finally, this survey was only conducted in China, which limits its generalization to other areas.

Conclusions
After the deblocking of China's COVID-19 pandemic strategy, the PR of Chinese college students were insufficient.Monthly contact with family, family function, self-efficacy, mental health status, and gender may provide more intervention strategies for future.

4. 2 .
Influencing Factors of PR among Chinese College Students after the Deblocking of China's COVID-19 Pandemic Strategy

Author
Contributions: B.-A.L. and L.-L.Q. made substantial contributions to the design, analysis, and interpretation of data in this manuscript; R.Z., J.P., J.-Y.L., B.-A.L. and L.-L.Q. were involved in drafting and revising.All authors have read and agreed to the published version of the manuscript.

Table 1 .
Scores of psychological resilience.

Table 2 .
Score of family function of college students in China.

Table 4 .
Comparison of psychological resilience score among gender.

Table 5 .
Distribution of PR among different characteristic college students (N = 1078).
* Stable marital status: refers to married and remarried; unstable marital status: refers to divorced, widowed, unmarried, and other marital status, the same below; # p < 0.05.

Table 6 .
Correlations of PR with other variables.

Table 7 .
Ordered logistic analysis of PR of college students in China.

Table 8 .
Ordered logistic analysis of PR of college students in China by gender.The PR of College Students in China after the Deblocking of China's COVID-19 Pandemic