Meaning, Not Its Search, May Link Pandemic Fear to Teen PTSD

A cross-sectional study of more than 1,200 Chinese middle school students has found that fear of COVID-19 was positively associated with symptoms of post-traumatic stress disorder, and that a pre-existing sense of meaning in life—rather than the active search for meaning—statistically accounted for part of that association. The research, published in Frontiers in Psychology by Wen Lv, Yuguang Wang, Zeling Long, Shienyu Fei, Juan Song and Wei Chen of Guizhou Normal University and collaborators, also found that gender shaped part of the pathway, although the overall indirect effect did not differ significantly between boys and girls.

The study recruited 1,291 students aged 11 to 18 years from four middle schools in Guizhou, Henan, and Hubei provinces, using convenience sampling. Roughly half of the sample were girls (656, or 50.8 percent) and half were boys (635, or 49.2 percent), with a mean age of 14.13 years. Data were collected between November and December 2022, a period that coincided with a major policy shift in China’s pandemic response, a timing factor the authors note they could not fully account for. Students whose questionnaires were incomplete, who reported significant pre-pandemic trauma, or who had been diagnosed with a severe mental disorder were excluded, leaving a final response rate of 92.2 percent.

Participants completed three standardized self-report instruments. Fear of COVID-19 was measured with the seven-item Fear of COVID-19 Scale, which produced a Cronbach’s alpha of 0.90. PTSD symptoms were assessed with the 17-item PTSD Checklist, Civilian Version, answered with reference to COVID-19-related experiences; its alpha was 0.93. Meaning in life was measured with the 10-item Meaning in Life Questionnaire, which distinguishes two dimensions: Presence of Meaning, an existing sense that life has purpose and coherence, and Search for Meaning, the active pursuit of purpose. A score of 50 or higher on the PTSD checklist served only as a screening threshold for probable PTSD, not as a clinical diagnosis.

The headline result was a positive correlation between fear of COVID-19 and PTSD symptoms (r = 0.31, p < 0.001). After adjusting for age, the total effect of fear on symptoms remained significant (B = 0.557, p < 0.001), and the model containing fear and age explained 9.9 percent of the variance in PTSD symptoms. Descriptively, girls reported slightly higher PTSD symptoms and slightly higher fear of COVID-19 than boys, while boys reported slightly higher scores on both meaning dimensions. Notably, 72 participants—5.6 percent of the sample—met the screening cutoff for probable PTSD, a figure the authors describe as comparable to previous adolescent pandemic studies and indicative of a substantial mental health burden in community samples.

The mediation analyses revealed an asymmetry between the two meaning dimensions. In age-adjusted simple mediation models, the indirect effect through Presence of Meaning was significant (B = 0.059, 95 percent bootstrap confidence interval [0.031, 0.089]), while the indirect effect through Search for Meaning was not (B = 0.005, 95 percent CI [−0.001, 0.015]). When both dimensions were entered simultaneously in a parallel model, Presence of Meaning again showed a significant unique indirect effect (B = 0.060, 95 percent CI [0.032, 0.092]), whereas Search for Meaning did not (B = −0.002, 95 percent CI [−0.009, 0.004]). In other words, fear of COVID-19 was associated with lower reported presence of meaning, and lower presence of meaning was in turn associated with more PTSD symptoms, while the active search for meaning did not independently transmit the association.

Gender entered the picture at the second stage of the pathway. The interaction between Presence of Meaning and gender significantly predicted PTSD symptoms (B = −0.159, p = 0.044): the negative association between having meaning and symptoms was stronger among girls (B = −0.451) than among boys (B = −0.292). Conditional indirect effects through Presence of Meaning were significant for both boys (B = 0.046, 95 percent CI [0.022, 0.075]) and girls (B = 0.071, 95 percent CI [0.037, 0.110]). Crucially, however, the index of moderated mediation was not significant (0.025, 95 percent CI [−0.003, 0.059]), meaning the overall indirect pathway from fear through meaning to symptoms did not differ statistically by gender.

A parallel pattern emerged for Search for Meaning. The Search by Gender interaction was significant in the PTSD equation (B = −0.231, p = 0.016), with simple-slope analyses showing that searching for meaning was not significantly associated with symptoms among boys (B = 0.019, p = 0.775) but was significantly negative among girls (B = −0.213, p = 0.002). Yet because the link from fear to searching was itself not significant, the conditional indirect effects were non-significant for both groups, and the moderated mediation index again fell short of significance (0.012, 95 percent CI [−0.002, 0.034]). The authors stress that gender differences were confined to the meaning-to-symptom paths rather than the full mediated process.

The theoretical framing draws on three traditions. Emotional processing theory, which locates PTSD in pathological fear structures, motivates the expectation that persistent pandemic-related fear would co-occur with trauma symptoms, particularly in a developmental period marked by heightened emotional reactivity and disrupted social routines. Meaning-making theory, together with terror management theory, suggests that existential threat can strain the beliefs that buffer anxiety, and that a stable sense of meaning may serve a protective function. The authors propose that during an acute crisis, adolescents with well-developed pre-existing meaning structures had a ready cognitive framework for interpreting stress, whereas effortful searching may have been too resource-intensive to yield immediate benefits. They are careful to flag this as a hypothesis, since the cross-sectional data cannot test the underlying mechanism.

The study’s limitations are considerable and are addressed at length by the authors. The cross-sectional design cannot establish causality or temporal order; it is equally plausible that adolescents with pre-existing subclinical PTSD symptoms reported greater fear, or that meaning and symptoms influence each other bidirectionally. The PCL-C does not anchor responses to a specific DSM-5 Criterion A event, so some reported symptoms may not have been exclusively pandemic-related. Single stochastic regression imputation was used for missing data, which may understate uncertainty. Convenience sampling from four schools limits generalizability, and a systematic comparison of retained versus excluded participants was not possible because demographic information for excluded cases was often incomplete. Gender was measured as a binary self-report item, which does not capture the full spectrum of gender identity, and the configural measurement model for the meaning questionnaire showed acceptable but not optimal fit (RMSEA = 0.103), although metric and scalar invariance across gender were fully supported.

The authors conclude that, after adjusting for age, fear of COVID-19 was positively associated with PTSD symptoms and that Presence of Meaning—but not Search for Meaning—showed a significant indirect association, with gender moderating the second-stage paths without altering the overall indirect effects. They emphasize that these cross-sectional findings underscore the conceptual distinction between having meaning and seeking meaning, but cannot establish whether these associations are causal or whether interventions targeting meaning would reduce PTSD symptoms. Longitudinal and experimental research, they write, will be needed to answer those questions, and any implications for intervention remain provisional until such studies are carried out.

Subject of Research: Associations between fear of COVID-19, meaning in life, and PTSD symptoms in Chinese adolescents

Article Title: Fear of COVID-19 and PTSD symptoms in adolescents: the mediating role of meaning in life and the moderating role of gender

Article References: Lv, W., Wang, Y., Long, Z., Fei, S., Song, J., & Chen, W. (2026). Fear of COVID-19 and PTSD symptoms in adolescents: the mediating role of meaning in life and the moderating role of gender. Frontiers in Psychology, 17, Article 1912062. https://doi.org/10.3389/fpsyg.2026.1912062

Image Credits: AI Generated

DOI: 10.3389/fpsyg.2026.1912062

Keywords: adolescents, COVID-19, PTSD symptoms, fear of COVID-19, meaning in life, Presence of Meaning, Search for Meaning, gender differences, moderated mediation, cross-sectional study, mental health, China