Emotion regulation and mental health in college students during coronavirus pandemic lockdowns

Table 1 Synthesis of mental health outcomes among college students during coronavirus disease 2019 lockdowns (expanded)

Ref.	Country/region	Sample size	Key findings (prevalence/predictors)	Notable ER/coping factors examined
Zhao et al[4]	China	494	Depression: 65.0%; anxiety: 69.4%; stress: 50.8%	Compensatory spending (β = 0.13-0.19), binge eating (β = 0.14-0.19), recreational activities (β = -0.25 to -0.30) as key ER habits
Cao et al[2]	China	7143	Anxiety: 24.9% (mild: 21.3%; moderate: 2.7%; severe: 0.9%)	Family instability and economic concerns as major stressors
Liu et al[11]	United States	898	Depression: 43.5%; anxiety: 45.4%	COVID-19 exposure, financial stress, weak social support
Browning et al[13]	United States	1621	Significant increases in depression/anxiety from pre-pandemic baseline	Loneliness was the strongest predictor; coping through substance use was a risk factor
Li et al[14]	China	746217	Approximately 35% experienced psychological distress	Poor sleep quality and family relationships were major correlates
Pfefferbaum and North[15]	Review	N/A	Summarized acute and chronic stress responses in youth	Highlighted disruption of routines and uncertainty as key mediators
Aristovnik et al[16]	62 countries	31212 students	High levels of anxiety (37.5%) and depression (33.6%)	Academic stress, isolation, and concerns about academic future were top stressors

ER: Emotion regulation; COVID-19: Coronavirus disease 2019; N/A: Not applicable.

Table 2 Risk and protective factors for student mental health during lockdowns: A thematic synthesis

Factor category	Specific factors	Association with mental health	Proposed mechanism/ER framework	Ref.
Maladaptive ER/risk factors	Compensatory spending	Positive (β approximately 0.13-0.19)[1]	Experiential avoidance; mood repair; financial stress feedback loop	Zhang and Ma[7]; Rajkumar[8]
	Binge eating/emotional eating	Positive (β approximately 0.14-0.19)[1]	Emotional dysregulation; avoidance; physiological guilt/shame cycles	Coakley et al[19]; Rodríguez-Rey et al[28]
	Problematic internet/social media use	Positive	Avoidance, social comparison, sleep disruption	Marciano et al[20]; Boursier et al[21]
	Rumination	Strong positive	Perseverative cognitive focus on distress; amplifies negative affect	Cao et al[2]
Adaptive ER/protective factors	Recreational activities/hobbies	Negative (β approximately -0.25 to -0.30)[1]	Behavioral activation; attentional deployment; flow/mastery experiences	Quan et al[18]; Heumann et al[35]
	Physical activity/exercise	Negative (βapproximately -0.22)	Behavioral activation; physiological stress buffering (e.g., endorphins)	Stanton et al[10]
	Mindfulness/acceptance	Negative	Reduced experiential avoidance; decentering from negative thoughts	Hong et al[26]; Conversano et al[27]
	Cognitive reappraisal	Negative	Reinterpreting stressors; finding meaning; promoting psychological flexibility	Gross[5]
	Social support (virtual/in-person)	Negative (β approximately -0.19)	Social sharing; co-regulation; belongingness	Ye et al[9]; Ooi et al[17]
Contextual and demographic moderators	Lower socioeconomic status	Positive	Increased material hardship, less access to resources, higher baseline stress	Quan et al[18]; Amerio et al[56]
	High academic stress	Strong positive	Threat to self-efficacy and future prospects; performance pressure	Steare et al[38]; Sundarasen et al[54]
	Poor sleep quality	Strong positive	Bidirectional relationship; impairs prefrontal cortex function needed for ER	Cellini et al[55]; Alvaro et al[59]
	Loneliness/lack of social integration	Strong positive	Unmet need for connection; lack of co-regulation opportunities	Bu et al[51]; Killgore et al[52]

ER: Emotion regulation.

Table 3 Theoretical frameworks for understanding emotion regulation and mental health during crisis

Theoretical framework	Core tenet	Application to pandemic findings	Ref.
Process model of emotion regulation (Gross)	ER unfolds over time via situation selection, modification, attentional deployment, cognitive change, and response modulation	Lockdowns limited situation selection/modification, increasing burden on cognitive change (reappraisal) which many found difficult, leading to maladaptive response modulation (e.g., binge eating)	Gross[5]
Transdiagnostic/RDoC approach	Shared underlying mechanisms (like ER deficits) cut across traditional diagnostic categories	Explains high comorbidity (r approximately 0.85-0.96) of depression, anxiety, and stress; points to interventions targeting shared processes (e.g., intolerance of uncertainty)	Woon et al[33]; Keshavan et al[34]
Allostatic load/chronic stress model	Chronic stress leads to wear-and-tear on physiological systems (neuroendocrine, immune), impairing brain function and mental health	Lockdowns were a chronic stressor; allostatic load links pandemic stress to long-term mental and physical health risks	McEwen[31]; Guidi et al[32]
Behavioral models (e.g., BA for depression)	Depression is maintained by a cycle of avoidance, reduced activity, and loss of positive reinforcement	Loss of campus activities and routines depleted positive reinforcement; protective factors like recreational activities worked via behavioral activation	Heumann et al[35]
Social baseline theory	The human brain expects proximity to social resources; distancing taxes our neural and metabolic resources for regulation	Social isolation forced individuals to “go it alone” neurologically, depleting resources for ER and increasing distress	Coan and Sbarra[36]; Eisenberger[37]

ER: Emotion regulation; RDoC: Research Domain Criteria; BA: Behavioral activation.

Table 4 Proposed intervention framework based on review evidence

Intervention level	Target	Example strategies	Theoretical basis
Universal prevention (all students)	Promote adaptive ER, reduce stigma	Curriculum-integrated psychoeducation on stress management and ER skills[5,26]. Campus-wide wellness campaigns promoting physical activity[10], sleep[55,59], hobbies[18]. Training faculty in psychological first aid and referral pathways	Mental health literacy; positive psychology; behavioral activation models[35]
Selected prevention (at-risk groups)	Address specific risk factors	Workshops for students with financial stress (financial literacy, budgeting)[7,8,18]. Skills groups for emotional eating[23,24] or problematic internet use[20,21]. Support groups for international students, low-income students[18,51]	Cognitive-behavioral therapy; dialectical behavior therapy skills
Indicated intervention/treatment (symptomatic students)	Treat clinical symptoms	Increased access to telehealth cognitive-behavioral therapy, acceptance and commitment therapy, or unified protocol[34]. Prescription and guidance for use of evidence-based mental health apps. Collaboration with campus health services for medication management if needed	Transdiagnostic cognitive-behavioral therapy[33,34]; pharmacotherapy
Environmental/policy	Modify structural determinants	Flexible academic policies (deadline extensions, pass/fail options)[16,38,54]. Emergency funds and grants for students in financial need[18,56]. Ensuring affordable, reliable internet and suitable study spaces. Creating and subsidizing opportunities for safe social/recreational engagement[4,9,17,18]	Socioecological model; public health approach

ER: Emotion regulation.