Posttraumatic stress symptom trajectories of Chinese university students during the first eight months of the COVID-19 pandemic and their association with cognitive reappraisal, expressive suppression, and posttraumatic growth

Objective: To identify the moderating effects of cognitive reappraisal (CR) and expressive suppression (ES) on the relationship between posttraumatic stress (PTS) symptoms and posttraumatic growth (PTG) in university students. Methods: The survey included 1 987 Chinese university students who completed questionnaires on PTS symptoms in February 2020, with three follow-up surveys at two-month intervals until August 2020. We assessed CR and ES at February 2020 and PTG at August 2020. Growth mixture modeling was used to classify the PTS symptom trajectories. Multinomial logistic regression was used to recognize the predictors of class membership. The relationships among PTS symptoms, CR, ES, and PTG were examined using multi-group path analysis. Results: Sex, SARS-CoV-2 infection of a family member or friend, number of siblings, CR, and ES were significantly associated with PTS symptoms. Three latent classes were identified: 'Increasing PTS' (n=205, 10.0%) who had rapid deterioration of PTS symptoms, 'Moderate PTS' (n=149, 8.0%) who had a high level of PTS symptoms at the beginning and slightly increasing, and 'Persistent Minimal PTS' (n=1 633, 82.0%), who had slow resolution of PTS symptoms over time. Male, SARS-CoV-2 infection of a family member or friend, and having a lower CR and a higher ES, were more likely to have 'Increasing PTS'. PTS at February 2020 predicted PTG only in 'Increasing PTS' class, and both CR and ES had moderating effects on the conversion between them. Conclusions: Most students recovered from posttraumatic stress of COVID-19 pandemic, but a small proportion expeienced increasing PTS symptoms, and those with this condition may benefit from emotional regulation intervention.