Depression, Anxiety, and Cognitive Distortion among College Students: A Cross-Lagged Prospective Network Study during and after the COVID-19 Pandemic

Background. The high prevalence of depressive and anxiety symptoms among college students during the COVID-19 pandemic raised serious global public health concerns. Grounded in Beck’s cognitive theory, we tested whether cognitive distortion (included form of rumination) influenced the development of depression and anxiety during and after the pandemic. Materials and Methods. A total of 2,709 college students in southern China completed self-report measures of depression and anxiety as part of a psychological screening questionnaire during the COVID-19 lockdown. Six months later, after lockdown, 689 of these students completed the same questionnaires. Results. A cross-sectional network analysis showed that relative to their self-reports during the pandemic, college students reported fewer depressive symptoms and higher anxiety symptoms after the pandemic. A cross-lagged network among depression, anxiety, and cognitive distortion exhibited a consistent pattern, with symptom rumination serving as central node. Surprisingly, depression predicted later anxiety, but anxiety did not predict later depression. Conclusion. Symptoms of depression and anxiety were uniquely related to different cognitive distortions, suggesting different mechanisms of development during the pandemic. Symptom rumination should be considered a key target in cognitive behavioral therapy.