The outbreak of the COVID-19 emerged in Wuhan in December 2019 is an important public health problem (Hui et al., 2020; Li et al., 2020b). The WHO declared the outbreak of the novel coronavirus a global health emergency (World Health Organization, 2020). The COVID-19 outbreak is expected to continue in the coming years (Bao et al., 2020; Paules et al., 2020). It has been reported that the new infectious diseases may cause an increase in anxiety, depression, and stress in the general population (Erdoğan and Hocaoğlu, 2020; Tull et al., 2020; Kim et al., 2021). Facing the COVID-19 virus, a new infectious disease has resulted in a high prevalence of mental health problems in China and other countries (Chan et al., 2020; Choi et al., 2020; Ding et al., 2020). This increased stress in individuals, especially university students, can cause elevated anxiety levels and in turn compromise the sleep quality (Huang and Zhao, 2020; Zacher and Rudolph, 2020).

Meanwhile, the employment situation for university graduates is more and more serious. In recent years, the number of university graduates in China is gradually increasing, but the employment rate for university graduates is decreasing year by year (Li et al., 2020a). In 2020, the number of university graduates in China will reach 8.74 million. With the increasing uncertainty of social employment demand, the employment situation is complex and changeable. The employment of university graduates is facing severe challenges, and employment pressure is greatly increased (Liu et al., 2009; Hou et al., 2019).

It is extremely important to determine the factors that affect the health of university graduates in combating the COVID-19 pandemic. Anxiety is a normal reaction to the novel coronavirus pneumonia and employment pressure (Zhang et al., 2013; Gao et al., 2019). However, some students show overwhelming anxiety reactions, which would affect their daily function and employment mentality (Zhang et al., 2020). Sleep disorder is a common symptom of anxiety, which is one of the most concerned problems of university students and one of the main reasons for psychological counseling (Farrah et al., 2009). It is important for university graduates to obtain quality sleep to concentrate on completing their studies and actively look for jobs. Also, quality sleep plays an important role in defending against various infections (Ohrnberger et al., 2017; Besedovsky and Lange, 2019).

Under the dual influence of COVID-19 and the increasing employment pressure, the mental health and sleep disorders of university graduates have become increasingly prominent, which have attracted the attention of all sectors of society. In this study, 1,200 university graduates were selected to analyze their perceived stress, state anxiety, trait anxiety, and sleep quality to provide a reference for improving the mental health status of university graduates.

In the fight against the COVID-19 pandemic, it is extremely important to identify the factors that affect the psychological health of university graduates. A general picture of the psychological state of university graduates in China during the COVID-19 pandemic has been presented. Pandemics have many negative effects on society, economy, psychology, and spirit (Fong et al., 2020; Gao et al., 2020; Salari et al., 2020; Wang et al., 2020; Zhang and Ma, 2020; Li et al., 2020c). Under the pressure of study and employment, the mental health of university graduates has always been the focus of colleges and society (Kahn, 2010; Altonji et al., 2016). Therefore, the impact of novel coronavirus pneumonia, the fear of leaving campus, fierce competition, huge employment pressure, and worries about future development can cause serious mental health problems for university graduates. Lack of sleep or poor sleep quality can lead to college students’ fatigue, inattentiveness, low learning efficiency, and other undesirable phenomena (Gadie et al., 2017; Barros et al., 2019; Cao et al., 2021).

Through this cross-sectional study, the mental health problems and the associated factors among Chinese university graduates with pressure increases exposed to COVID-19 were assessed. The degrees of the perceived stress, anxiety, and sleep quality of 1,200 participants were assessed using the Perceived Stress Scale, the State-Trait Anxiety Inventory, and the PSQI, respectively, which found that the mean perceived stress, state anxiety, trait anxiety, and sleep quality were moderate and found as 31.4±6.69, 46.67±5.80, 49.45±5.54, and5.94±2.47, respectively.

The findings of this study demonstrated that the perceived stress, anxiety, and sleep quality of university graduates were affected by some demographic variables. The results showed that the detection rates of state anxiety and trait anxiety were 48.63 and 49.50%. A considerable number of university graduates had different degrees of state anxiety and trait anxiety, which was significantly higher than the detection rates of state anxiety and trait anxiety on the adult population in other studies (Madrid-Valero et al., 2017). The reason for this analysis is that the university graduates will face more pressure, unclear future planning, and fierce competition for employment under the influence of COVID-19. This shows that during the period of COVID-19, universities and all sectors of society should give university graduates more care and psychological support to help them to clear up negative emotions and avoid serious harm to their mental health.

In addition, the detection rates of state anxiety and trait anxiety of different genders and different majors were similar, which indicated that there was a high risk of anxiety for both males and females, regardless of their majors. This study found that state anxiety levels were significantly higher in females than males (p<0.05). This was consistent with the greater pressure on female employment in the current society. The detection rates of state anxiety and trait anxiety on rural students were higher than those in urban areas. It was speculated that it may be due to the low financial support of rural families for further study and the great economic pressure of employment for their families. Serving as reserve talents for the healthcare system, medical students were not yet professionally matured enough to face one of the worst global public health crises. The perceived stress and anxiety induced by the COVID-19 epidemic might affect medical students’ future career choice (Zheng et al., 2021).

There was a close relationship between state-trait anxiety and sleep quality of university graduates. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes among university graduates during COVID-19. The regression analysis showed that each factor and total score of sleep quality were positively correlated with state and trait anxiety. They can influence each other and form a vicious circle (Liu et al., 2016). The relationship between sleep quality and anxiety should be paid attention in order to reduce the state and trait anxiety of university graduates. The results of the study showed that trait anxiety had a significant predictive effect on subjective sleep quality, sleep duration, and PSQI total score.

The study managed to capture some immediate positive and negative mental health impacts of the COVID-19 pandemic. The results showed that rural graduates looking for employment, especially students majored in liberal arts, were found to have a high risk of mental health symptoms that were not conducive to development and may need psychological support or interventions. Since the COVID-19 pandemic is still ongoing, these findings need to be confirmed and investigated in future.

This study is a cross-sectional study, which can not reveal the causal direction of the relationship between perceived stress, state-trait anxiety, and sleep quality. It needs to carry out a prospective cohort study to explore.

The effect of state anxiety on sleep quality is direct and significant. The trait anxiety can trigger and cause all kinds of sleep problems by influencing individual anxiety tendency steadily. In this study, the explanation rate of trait anxiety to the variance of PSQI is not high, which may also be due to this. Trait anxiety has an indirect effect on sleep quality, which mainly affects sleep quality through the mediating effect of state anxiety.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by the Ethics Committee of Xi’an University of Architecture and Technology. The patients/participants provided their written informed consent to participate in this study.

BL conceived the initial idea for the study and helped to study design. KQ designed the study, collected the data, performed the statistical analysis, and helped to recruit the participants. BL and YL contributed to intervention design and draft the manuscript. All authors have read and agreed to the published version of the manuscript.

This study is supported by the Excellent Project of University Student Work in Shaanxi Province (2020FXM06).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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