Association between mask wearing and anxiety symptoms during the outbreak of COVID 19: A large survey among 386,432 junior and senior high school students in China

AIM: To evaluate the association between mask wearing practice and the risk of anxiety symptoms during the COVID-19 epidemic among Chinese students aged 12–18 years old. METHODS: Totally, 386,432 junior and senior high school students were recruited using a cluster sampling method across three cities of Henan Province in China during February 4–12, 2020. Mask wearing practice was defined according to its type and the behavior exhibited in relation to wearing a mask. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the association between mask wearing and anxiety symptoms. RESULTS: Among the participants, compared with students who completely adhered to the all the mask wearing practice, students who did not adhere to all the mask wearing practice had 1.97 times more likely to suffer from anxiety symptoms (adjusted odds ratio (aOR) = 1.97; 95% confidence interval (CI): 1.74–2.22). Furthermore, compared with students who did not know the proper type of mask, students who knew the proper type of mask had a lower risk of anxiety symptoms (aOR = 0.78; 95%CI: 0.76–0.80). Students who adhered to proper behavior of mask wearing was associated with 34% decreased odds for anxiety symptoms (aOR = 0.68; 95%CI: 0.62–0.74). CONCLUSIONS: To conclude, proper mask wearing may be an important attribute that play a significant role in reducing the risk of anxiety symptoms among junior and senior school student. However, since this study is a cross-sectional study, prospective studies are needed to further verify.