The Corona Virus Disease 2019 (COVID-19) pandemic broke out suddenly at the beginning of 2020 in Wuhan, China and quickly spread across the whole country and other parts of the world (Chen et al., 2020, 2021; Dan, 2020; Li and Xu, 2020). Due to its highly contagious nature and unavailable treatment drugs, the public had to face a long period time of home quarantine, which not only increased the sensitivity of the general public to the new pandemic, but also posed a serious threat to people’s mental health (Dan, 2020; Liu, 2020; Liu et al., 2021).

In a public health crisis, risk perception plays an important role in affecting people’s mental health (Commodari et al., 2020; Ding et al., 2020). The public’s perceptions of risk as well as their emotional states are different; furthermore, the perceptions of cognitive risk are negatively correlated with depression in people in a public health crisis; therefore, when improving health policies for people’s mental health in public health crises, risk perception should be taken into consideration (Commodari et al., 2020; Ding et al., 2020).

Empirical studies have shown that the COVID-19 pandemic triggered emotional problems for the general public, such as anxiety and depression (Liu, 2020; Wang et al., 2020; Liu et al., 2021). Middle school students, in particular, are the most likely affected group by the COVID-19 pandemic (Commodari and La Rosa, 2020, 2021; Guessoum et al., 2020; Wang et al., 2021). They could not accurately identify the authenticity of information about this pandemic because of the rapid flood of complex information on the Internet and social media; moreover, they would have to study online at home because schools had been closed; consequently, they could easily develop feelings of loss of control and negative emotions; and the increased such feelings may lead to mental health problems such as anxiety and depression (Liu, 2020; Yu et al., 2020).

Since Wuhan first became the center of this pandemic, it is important to investigate the mental states of its middle school students during this major public health emergency when the entire city was locked down for the COVID-19 pandemic on January 23, during the lockdown of the city, and after the lockdown was lifted on April 8, 2020. Such investigations would provide important implications for the schools, middle school students, and their parents and guardians to cope with future major public health emergencies.

Major public health emergencies refer to the sudden occurrence of major infectious diseases, mass diseases of unknown origin, major food and occupational poisoning, and other events that may cause serious damage to the public health (Liu Y. Y. et al., 2020). Research has shown that anxiety and depression are the most common mental health problems that the general public can easily develop under the major public health emergencies (Loh et al., 2005; Motreff et al., 2020; Og et al., 2020; Türk et al., 2021).

For example, the outbreak of the severe acute respiratory syndrome (SARS) in some areas of China at the end of 2002 posed a threat to the health and security of the public and many affected individuals experienced anxiety and depression (Leppin and Aro, 2009; Main et al., 2011). Similarly, after the COVID-19 pandemic outbreak at the beginning of 2020, the public experienced stress response, accompanied by such psychological disorders as anxiety and depression (Liu C. H. et al., 2020). Anxiety was the first to appear, depression was the next; the more individuals were in the worst-hit areas, the higher their anxiety and depression levels would be (Breslau et al., 2008; Liu C. H. et al., 2020).

Anxiety and depression are also common among middle school students (Su, 2006; Hankin et al., 2015; Ling, 2019). Adolescent anxiety and emotional disorders manifested as nervousness, crying, and irritability, accompanied by corresponding cognitive, behavioral changes, and physical symptoms (Su, 2006; Ling, 2019). The prevalence of anxiety has a long-term negative impact on different aspects of children and adolescents’ lives, and affects their cognitive, behavioral, and social functioning at different life stages, leading to education failure, low self-confidence, low self-esteem, and depression (Hankin et al., 2015; Ling, 2019).

Depression is a psychological or psychiatric term, indicating a series of symptoms such as decreased energy and feeling despair (Gong et al., 2019). Adolescent depression and mood disorders become a slow and long-term process, manifested by a sudden decline in academic performance, deterioration in friend relationships, reduction in social interaction or recreational activities, changes in diet, sleep disorders, frequent fatigue, feeling worthless, and hopeless (Su et al., 2011; Frison and Eggermont, 2015). Depressive symptoms including depressive emotions (i.e., feelings of sadness, unhappiness, or depression over an indefinite period of time) are commonly found in adolescents (Hankin et al., 2015). Before the end of puberty, approximately 20% of girls and 7% of boys experience such depressive symptoms (Angold et al., 2002).

Anxiety and depression are more common among adolescents (Seipp, 1991; Ferrari et al., 2013; Ingul and Nordahl, 2013; Chen et al., 2020; Commodari et al., 2020; Guessoum et al., 2020; Chen et al., 2021; Yang, 2021). Many research studies have shown that the prevalence of anxiety and depression is higher in women than in men (Madasu et al., 2019; Yang, 2021). For example, in 2018, the global prevalence of major depression for 12 months was 5.8% for women and 3.5% for men (Ferrari et al., 2013). Also, gender and age are significantly related to anxiety and depression symptoms (Madasu et al., 2019; Yang, 2021). Female adolescents exhibit a higher risk of anxiety and depression during the COVID-19 pandemic and older adolescents are more depressed than younger adolescents (Chen et al., 2020, 2021). Adolescents suffering from anxiety and depression may experience a variety of adverse consequences, such as learning difficulties, poor academic performance, dropping out, not adapting to social relationships, and even risk of suicide (Seipp, 1991; Ingul and Nordahl, 2013).

Moreover, family is one of the most important environments for the development of adolescents’ mental health (Tian and Li, 2005; Xie et al., 2008; Türk et al., 2021). The higher the degree of family dysfunction, the higher the levels of adolescents’ anxiety and depression would be (Xie et al., 2008). For example, adolescents with separated parents have higher levels of anxiety and depression (Türk et al., 2021).

Middle school students belong to the vulnerable groups (i.e., under the age of 18), and the outbreak of the COVID-19 pandemic has triggered them anxiety and depression to varying degrees (Chen et al., 2020; Lorenzo et al., 2021). Wang et al. (2020) conducted a study on the psychological status of school-age children and adolescents under the influence of the COVID-19 pandemic, and the results showed that 10.4 and 22% of the measured participants showed anxiety and depression symptoms, respectively, furthermore, the older adolescents were more likely to develop depression than the younger ones.

In addition, since the outbreak of the COVID-19 pandemic, middle school students have been learning online courses and carrying out daily activities indoors. This lifestyle change (e.g., long-term home isolation, reduced social activities, online lessons, and increased parent-child time) as well as the threat of infection may lead to anxiety and depression (Jiang et al., 2020). Without proper psychological interventions, anxiety and depression in adolescents tend to persist into adulthood, causing more serious effects (Wang et al., 2020).

According to recent research studies, factors such as physical activity, social economic status (SES), and family cohesion are found to influence the mental health of middle school students (White, 2000; Pickett et al., 2017; Biddle et al., 2018; Pavey and Brown, 2019; Guhn et al., 2020). The following is a literature review summary of these factors.

First, long-term outdoor and sports activities can improve middle school students’ mental health (Bélanger et al., 2019). Middle school students who regularly engage in physical activities are significantly less troubled by psychological stress than those with little physical activity (Ding et al., 1998; Biddle et al., 2018; Yan et al., 2019). This is because active physical activity can reinforce themselves and make them feel good, thereby helping them overcome obstacles and become active (Pickett et al., 2017). Long sitting time and less physical activity significantly increase the chance of developing depression symptoms (Pavey and Brown, 2019). However, physical activity can cultivate their positive self-awareness, provide a sense of belonging, improve physical function, and relieve emotional distress (Driver and Ede, 2009).

Furthermore, the low SES of the family is a recognized risk of poor mental health development in children (Reiss, 2013). It is directly or indirectly related to their emotional development and mental health (Amone-P’Olak et al., 2009). The common SES indicators are family per capita income, parents’ education level, and their occupational status (Amone-P’Olak et al., 2009). Studies have shown that when adolescents are exposed to stressful life situations, among the three indicators that reflect the family’s socioeconomic status, per capita income, parents’ education, and parents’ occupational status, adolescents with higher parents’ education levels are less likely to experience mental health problems, while family income per capita and parents’ occupational status have little predictability for adolescents’ mental health (Reiss et al., 2019). During the pandemic, prolonged family isolation, uncertainty about the future, and financial difficulties experienced by the family may all trigger personal psychological symptoms (Karaman et al., 2021).

Finally, family cohesion refers to the degree of mutual commitment, help, and support between family members (Goodyer, 1998; Zhao et al., 2008; Williams, 2013; Yoon and Lian, 2020). Whether the emotional relationship between family members is concordant and harmonious has an important impact on the mental health of middle school students (Williams, 2013). Bad family relationships are one of the important factors that may cause them psychological problems (Goodyer, 1998; Yoon and Lian, 2020). Their overall level of anxiety is significantly negatively correlated with family cohesion; the lower the family cohesion, the easier it is for children to show depression and anxiety disorders (Yang, 2001; Craig et al., 2021). This may be due to the lack of emotional communication and mutual support between parents and children, and the family atmosphere is not harmonious, which not only makes children and adolescents feel lonely, depressed, withdrawn and silent, but also makes them feel greater pressure and cause anxiety (Wu et al., 2005). Furthermore, when they find that they are connected with their family and can rely on the family in a difficult situation, the family has an important influence on their behaviors and attitudes, and they perceive that the higher the support from the family, the less likely they are to engage in negative behavior (Jhang, 2017). This kind of support and communication between family members may be an important factor in relieving stress (Marta, 1997; Li and Xu, 2020; Zhu et al., 2021).

Recently, researchers have started to examine the impact of the COVID-19 pandemic on people’s lives in different countries (Commodari and La Rosa, 2020; Commodari et al., 2020; Ding et al., 2020; Guessoum et al., 2020). For example, Ding et al. (2020) investigated the psychological wellbeing and behavioral responses of adults in China during the COVID-19 pandemic and reported that risk perception and its associated factors significantly affect the mental health of people in public health crises. Furthermore, Commodari and La Rosa (2020) investigated 978 (males = 339; females = 639) secondary school students’ psychological experience of quarantine during the COVID-19 pandemic in Italy. The results indicated that females showed more significant psychological negative feelings about the quarantine experience. Similarly, Commodari and La Rosa (2021) examined 1017 secondary school students’ distance learning experiences during the first wave of the COVID-19 pandemic in Italy. The results indicated that distance learning was associated with a significant increase in student workload and consequent psychological distress related to homework.

To sum up, previous research studies on the COVID-19 pandemic were cross-sectional in nature (e.g., Chen et al., 2020, 2021). Few of them used longitudinal data for analysis. Moreover, most of previous research studies used quantitative methods in their investigations. The use of qualitative data would provide more in-depth information about the topic being investigated. To bridge these gaps, this study used both quantitative (i.e., a five-point Likert scale survey measuring participants’ self-perceived feelings of loss of control and negative emotions) and qualitative (i.e., focus group interviews examining the changes of participants’ emotional states) research methods in its design. Furthermore, it combined cross-sectional data with longitudinal data in its analysis.

This study aimed to examine the emotional states of middle school students in Wuhan City, when it was locked down for the COVID-19 pandemic on January 23, 2020, during the lockdown of the city, and after the lockdown was lifted on April 8, 2020. Specifically, the following four research questions guided the study: (a) what were the effects of gender, grade level, physical activity, SES, and family cohesion on participants’ emotional states as measured by their self-perceived feelings of loss of control and negative emotions? (b) What were their emotional states when Wuhan was locked down for the COVID-19 pandemic? (c) What were their emotional states when the lockdown was lifted in Wuhan? And (d) how did their emotional states change over the 1-year period after the lockdown was lifted?

The first research question was about the effects of gender, grade level, physical activity, SES, and family cohesion on Wuhan middle school students’ emotional states as measured by their self-perceived feelings of loss of control and negative emotions. Significant differences were found across all five demographic variables. Female students, Grade 9 students, students with low physical activities and SES, and students from low cohesion families experienced significantly higher level feelings of loss of control and negative emotions than male students, Grades 7 and 8 students, students with medium and high physical activities and SES, and students from high cohesion families, respectively. These results were consistent with the previous research findings (Ding et al., 1998; Reiss, 2013; Pavey and Brown, 2019; Yan et al., 2019; Chen et al., 2020; Commodari and La Rosa, 2020; Wang et al., 2020; Yoon and Lian, 2020).

It is important to note that the obtained effect size was small for each of these MANOVAs, which yielded significant group differences. Effect size identifies the strength of the conclusions about groups; and it often provides a more practical reading of the results (Creswell, 2014). The obtained small effect sizes suggest that these findings were significant only due the large sample size of the study. Therefore, these significant quantitative results should be interpreted with caution.

The second, third, and fourth research questions asked about the selected 15 middle school students’ emotional states (a) when Wuhan was locked down for the COVID-19 pandemic, (b) when the lockdown was lifted in Wuhan, and (c) the changes of their emotional states from the lockdown to the lifted lockdown, and then to today, i.e., 1-year after the lockdown was lifted. These 15 participants represented Grades 7, 8, and 9 student groups. Both similarities and differences were found among the three groups.

When Wuhan was locked down on January 23, 2020, all 15 participants except for one male student in Grade 7 group experienced worry, fear, feelings of loss of control, and negative emotions. The lockdown brought lifestyle changes to these middle school students. Home quarantine, reduced activities, online classes, and increased time with family members would create feelings of loss of control and negative emotions (Jiang et al., 2020; Wang et al., 2020).

On hearing the news that the lockdown was lifted on April 8, 2020, they felt cheerful, calm, relaxed, and excited. However, they became further anxious and worried because they thought they might experience the lockdown again. Unlike his peers, the male student in Grade 7 group felt sad about it because his parents had to go out to work and he would hardly see them at home.

After the lockdown was lifted, schools resumed and their life went back to normal. Their feelings changed over the past year, from being surprised, fearful, terrified schools when Wuhan was locked down, to being happy, cheerful, and excited when the lockdown was lifted, and to being worried, relaxed, and proud 1 year after the lifted lockdown. Grades 8 and 9 students are feeling relaxed and proud today because the pandemic is back in control and living in China becomes safe. However, several Grade 7 students explained that they are still feeling worried even today because the pandemic is still ongoing globally and it has become a serious threat to their mental health.

The present study was limited in the following three ways. First, it examined Wuhan middle school students’ emotional states during the COVID-19 pandemic only from a student perspective. Their parents’ perceptions were not included in the study. Therefore, the results should be interpreted with caution. Second, due to the limited availability and accessibility of participants, the second phase of data collection (i.e., focus group interviews) involved only 15 middle school students; this small sample size may limit the generalization of the findings to all the middle school students in Wuhan. Third, the interviews in this study were retrospective. Many factors may have distorted the participants’ answers in one way or the other when they reported about their emotional states in the past. Again, the results should be interpreted with caution.

In light of these limitations, the following two conclusions were reached. First, the middle school students in Wuhan experienced emotional changes during the COVID-19 pandemic when the city was locked down and they were home quarantined. During this major public health emergency, feelings of loss of control and negative emotions were commonly found in these students (Liu, 2020; Wang et al., 2020; Liu et al., 2021).

Second, the emotional states of middle school students in Wuhan changed substantially at different time nodes during this pandemic. They felt fearful and scared when the city was locked down; and these feelings were developed into feelings of loss of control and negative emotions (Liu Y. Y. et al., 2020; Main et al., 2011). They became happy and excited when the lockdown was lifted. During the 1 year after the lockdown was lifted, they were feeling relaxed and safe.

The results of this study have the important implications for the students, their parents, and the schools they attend. The middle school students should be aware of the threat of the major public health emergencies and be psychologically prepared for dealing with such emergencies. Their parents should notice their emotional changes during these emergencies and provide them with protection and guidance so that they can get over them successfully. The schools should also require their teachers and psychologists to provide students with guidance and consulting services so that they become psychologically and emotionally prepared before these emergencies occur.

The datasets presented in this article are not readily available because data belong to the funder. Requests to access the datasets should be directed to YH, 316678481@qq.com.

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.

YH: study design, data collection, and research funding provider. JH: data analysis, drafting, editing, revising, and proofreading the entire manuscript. TW: literature search, drafting literature review section, and data collection. SX: data collection and data preparation. JL: partial data collection and data preparation. All authors contributed to the article and approved the submitted version.

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.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.