quantitative research about mental health of students pdf

Examining the mental health of university students: A quantitative and qualitative approach to identifying prevalence, associations, stressors, and interventions

Affiliations.

• 1 Department of Dental Public Health and Behavioural Sciences, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA.
• 2 Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA.
• PMID: 35380931
• DOI: 10.1080/07448481.2022.2057192

Objective To identify the prevalence of anxiety, depression, and suicidal ideation that would place university students at risk for mental health disorders. To explore the source of stressors and possible interventions that may benefit student mental health in a university setting.

Participants: University students (n = 483) who had been learning remotely due to the COVID-19 pandemic.

Methods: A mixed-methods cross-sectional survey was administered in 2020.

Results: Students were at an increased rate of depression, anxiety and suicidal ideation as compared to the general population. Female gender, lack of social support, living alone, being a first-generation college student and COVID-19 were significantly associated with mental health disorders. Stressors were identified and categorized into themes and interventions were recognized that may improve student well-being.

Conclusion: Students enrolled in university programs appear to experience significant amounts of anxiety, depression, and suicidal ideation. Additional mental health education, resources, and support is needed.

Keywords: Anxiety; COVID-19; college students; depression; suicidal ideation.

• Anxiety / epidemiology
• Anxiety / psychology
• Cross-Sectional Studies
• Depression* / epidemiology
• Depression* / psychology
• Mental Health*
• Students / psychology
• Suicidal Ideation
• Universities

An Initiative Of NASPA and The Suder Foundation

Examining the mental health of university students: A quantitative and qualitative approach to identifying prevalence, associations, stressors, and interventions

Cody et al. / Journal of American College Health / April 2022

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This study sought to identify the prevalence of anxiety, depression, and suicidal ideation that would place university students at risk for mental health disorders and to explore the source of stressors and possible interventions that may benefit student mental health in a university setting. The sample consisted of University students (n = 483) who had been learning remotely due to the COVID-19 pandemic. The study used a mixed-methods cross-sectional survey administered in 2020. The authors found that students were at an increased rate of depression, anxiety and suicidal ideation as compared to the general population. Female gender, lack of social support, living alone, being a first-generation college student and COVID-19 were significantly associated with mental health disorders. Stressors were identified and categorized into themes and interventions were recognized that may improve student well-being. Students enrolled in university programs appear to experience significant amounts of anxiety, depression, and suicidal ideation. Additional mental health education, resources, and support are needed.

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This paper is in the following e-collection/theme issue:

Published on 3.9.2020 in Vol 22 , No 9 (2020) : September

Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study

Authors of this article:

Original Paper

• Changwon Son 1 , BS, MS   ; 
• Sudeep Hegde 1 , BEng, MS, PhD   ; 
• Alec Smith 1 , BS   ; 
• Xiaomei Wang 1 , BS, PhD   ; 
• Farzan Sasangohar 1, 2 , BA, BCS, MASc, SM, PhD  

1 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, United States

2 Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, United States

Corresponding Author:

Farzan Sasangohar, BA, BCS, MASc, SM, PhD

Department of Industrial and Systems Engineering

Texas A&M University

College Station, TX, 77843

United States

Phone: 1 979 458 2337

Email: [email protected]

Background: Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus.

Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students.

Methods: We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods.

Results: Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms.

Conclusions: Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students.

Introduction

Mental health issues are the leading impediment to academic success. Mental illness can affect students’ motivation, concentration, and social interactions—crucial factors for students to succeed in higher education [ 1 ]. The 2019 Annual Report of the Center for Collegiate Mental Health [ 2 ] reported that anxiety continues to be the most common problem (62.7% of 82,685 respondents) among students who completed the Counseling Center Assessment of Psychological Symptoms, with clinicians also reporting that anxiety continues to be the most common diagnosis of the students that seek services at university counseling centers. Consistent with the national trend, Texas A&M University has seen a rise in the number of students seeking services for anxiety disorders over the past 8 years. In 2018, slightly over 50% of students reported anxiety as the main reason for seeking services. Despite the increasing need for mental health care services at postsecondary institutions, alarmingly, only a small portion of students committing suicide contact their institution counseling centers [ 3 ], perhaps due to the stigma associated with mental health. Such negative stigma surrounding mental health diagnosis and care has been found to correlate with a reduction in adherence to treatment and even early termination of treatment [ 4 ].

The COVID-19 pandemic has brought into focus the mental health of various affected populations. It is known that the prevalence of epidemics accentuates or creates new stressors including fear and worry for oneself or loved ones, constraints on physical movement and social activities due to quarantine, and sudden and radical lifestyle changes. A recent review of virus outbreaks and pandemics documented stressors such as infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma [ 5 ]. Much of the current literature on psychological impacts of COVID-19 has emerged from the earliest hot spots in China. Although several studies have assessed mental health issues during epidemics, most have focused on health workers, patients, children, and the general population [ 6 , 7 ]. For example, a recent poll by The Kaiser Family Foundation showed that 47% of those sheltering in place reported negative mental health effects resulting from worry or stress related to COVID-19 [ 8 ]. Nelson et al [ 9 ] have found elevated levels of anxiety and depressive symptoms among general population samples in North America and Europe. However, with the exception of a few studies, notably from China [ 10 - 12 ], there is sparse evidence of the psychological or mental health effects of the current pandemic on college students, who are known to be a vulnerable population [ 13 ]. Although the findings from these studies thus far converge on the uptick of mental health issues among college students, the contributing factors may not necessarily be generalizable to populations in other countries. As highlighted in multiple recent correspondences, there is an urgent need to assess effects of the current pandemic on the mental health and well-being of college students [ 14 - 17 ].

The aim of this study is to identify major stressors associated with the COVID-19 pandemic and to understand their effects on college students’ mental health. This paper documents the findings from online interview surveys conducted in a large university system in Texas.

Study Design

A semistructured interview survey guide was designed with the purpose of assessing the mental health status of college students both quantitatively and qualitatively. In addition, the interview aimed to capture the ways that students have been coping with the stress associated with the pandemic situation. First, our study assesses participants’ general stress levels using the Perceived Stress Scale-10 (PSS) [ 18 ]. PSS is a widely used instrument to measure overall stress in the past month [ 19 ]. Second, participants were asked if their own and peers’ (two separate questions) stress and anxiety increased, decreased, or remained the same because of the COVID-19 pandemic. For those who indicated increased stress and anxiety during the pandemic, we questioned their stress coping strategies and use of available mental health counseling services. We then elicited pandemic-specific stressors and their manifestations across 12 academic-, health-, and lifestyle-related categories of outcomes such as effects on own or loved ones’ health, sleeping habits, eating habits, financial situation, changes to their living environment, academic workload, and social relations. Students were also asked about the impact of COVID-19 on depressive and suicidal thoughts. These constructs were derived from existing literature identifying prominent factors affecting college students’ mental health [ 20 , 21 ]. Feedback on the severity of COVID-19’s impact on these aspects were elicited using a 4-point scale: 0 (none), 1 (mild), 2 (moderate), and 3 (severe). Participants were asked to elaborate on each response. Third, participants were guided to describe stressors, coping strategies, and barriers to mental health treatment during a typical semester without associating with the COVID-19 pandemic. Although multiple analyses of the collected data are currently under progress, PSS results and the COVID-19–related findings are presented in this paper.

Participants

Participants were recruited from the student population of a large university system in Texas, United States. This particular university closed all their campuses on March 23, 2020, and held all its classes virtually in response to the COVID-19 pandemic. In addition, the state of Texas issued a stay-at-home order on April 2, 2020. Most interviews were conducted about 1 month after the stay-at-home order in April 2020. Figure 1 illustrates the trend of cumulative confirmed cases and a timeline of major events that took place in the university and the state of Texas. Participants were recruited by undergraduate student researchers through email, text messaging, and snowball sampling. The only inclusion criteria for participation was that participants should have been enrolled as undergraduate students in the university at the time of the interviews.

The interviews were conducted by 20 undergraduate researchers trained in qualitative methods and the use of the interview survey guide described above. None of the authors conducted the interviews. All interviews were conducted via Zoom [ 22 ] and were audio recorded. The recordings were later transcribed using Otter.ai [ 23 ], an artificial intelligence–based transcription service, and verified for accuracy manually. Prior to the interview, participants were provided an information document about the study approved by the university’s Institutional Review Board (No 2019-1341D). Upon verbal consent, participants were asked to respond to a questionnaire about their demographic information such as age, gender, year of college, and program of study before completing the interview. Participation was voluntary and participants were not compensated.

Data Analysis

First, descriptive statistics were compiled to describe participants’ demographics (eg, age, gender, academic year, and major) and the distribution of the ratings on PSS-10 survey items. A total PSS score per participant was calculated by first reversing the scores of the positive items (4-7, 9, and 10) and then adding all the ten scores. A mean (SD) PSS score was computed to evaluate the overall level of stress and anxiety among the participants during the COVID-19 pandemic. Second, participants’ answers to 12 academic-, health-, and lifestyle-related questions were analyzed to understand relative impacts of the pandemic on various aspects of college students’ mental health. Percentages of participants who indicated negative ratings (ie, mild, moderate, or severe influence) on these questions were calculated and ranked in a descending order. Qualitative answers to the 12 stressors and coping strategies were analyzed using thematic analysis [ 24 , 25 ] similar to the deductive coding step in the grounded theory method [ 26 ]. A single coder (CS), trained in qualitative analysis methods, analyzed the transcripts and identified themes using an open coding process, which does not use a priori codes or codes created prior to the analysis and places an emphasis on information that can be extracted directly from the data. Following the identification of themes, the coder discussed the codes with two other coders (XW and AS) trained in qualitative analysis and mental health research to resolve discrepancies among related themes and discuss saturation. The coders consisted of two Ph.D. students and one postdoctoral fellow at the same university. MAXQDA (VERBI GmbH) [ 27 ] was used as a computer software program to carry out the qualitative analysis.

Of the 266 university students initially recruited by the undergraduate researchers, 17 retreated and 249 participated in this study. There were 3 graduate students and 51 participants who had missing data points and were excluded, and data from 195 participants were used in the analysis. The average age was 20.7 (SD 1.7) years, and there were more female students (111/195, 57%) than male students (84/195, 43%). Approximately 70% of the participants were junior and senior students. About 60% of the participants were majoring in the college of engineering, which was the largest college in the university population ( Table 1 ). The mean PSS score for the 195 participants was 18.8 (SD 4.9), indicating moderate perceived stress in the month prior to the interview ( Table 2 ).

a PSS: Perceived Stress Scale-10.

Challenges to College Students’ Mental Health During COVID-19

Out of 195 participants, 138 (71%) indicated that their stress and anxiety had increased due to the COVID-19 pandemic, whereas 39 (20%) indicated it remained the same and 18 (9%) mentioned that the stress and anxiety had actually decreased. Among those who perceived increased stress and anxiety, only 10 (5%) used mental health counseling services. A vast majority of the participants (n=189, 97%) presumed that other students were experiencing similar stress and anxiety because of COVID-19. As shown in Figure 2 , at least 54% (up to 91% for some categories) of participants indicated negative impacts (either mild, moderate, or severe) of COVID-19 on academic-, health-, and lifestyle-related outcomes. The qualitative analysis yielded two to five themes for each category of outcomes. The chronic health conditions category was excluded from the qualitative analysis due to insufficient qualitative response. Table 3 presents the description and frequency of the themes and select participant quotes.

a Not every participant provided sufficient elaboration to allow for identification of themes, so the frequency of individual themes does not add up to the total number of participants who indicated negative impacts of the COVID-19 outbreak.

b The five-digit alphanumeric value indicates the participant ID.

c TA: teaching assistant.

Concerns for One’s Own Health and the Health of Loved Ones

A vast majority of the participants (177/195, 91%) indicated that COVID-19 increased the level of fear and worry about their own health and the health of their loved ones. Over one-third of those who showed concern (76/177, 43%) were worried about their families and relatives who were more vulnerable, such as older adults, those with existing health problems, and those who are pregnant or gave birth to a child recently. Some of the participants (26/177, 15%) expressed their worry about their family members whose occupation increased their risk of exposure to COVID-19 such as essential and health care workers. Some participants (19/177, 11%) specifically mentioned that they were worried about contracting the virus.

Difficulty With Concentration

A vast majority of participants (173/195, 89%) indicated difficulty in concentrating on academic work due to various sources of distraction. Nearly half of them (79/173, 46%) mentioned that their home is a distractive environment and a more suitable place to relax rather than to study. Participants mentioned that they were more prone to be interrupted by their family members and household chores at home. Other factors affecting students’ concentration were lack of accountability (21/173, 12%) and social media, internet, and video games (19/173, 11%). Some (18/173, 10%) stated that online classes were subject to distraction due to lack of interactions and prolonged attention to a computer screen. Additionally, monotonous life patterns were mentioned by some to negatively affect concentration on academic work (5/173, 3%).

Disruption to Sleep Patterns

A majority of participants (168/195, 86%) reported disruptions to their sleep patterns caused by the COVID-19 pandemic, with over one-third (38%) reporting such disruptions as severe. Half of students who reported some disruption (84/168, 50%) stated that they tended to stay up later or wake up later than they did before the COVID-19 outbreak. Another disruptive impact brought by the pandemic was irregular sleep patterns such as inconsistent time to go to bed and to wake up from day to day (28/168, 17%). Some (12/168, 7%) reported increased hours of sleep, while others (10/168, 6%) had poor sleep quality.

Increased Social Isolation

A majority of participants answered that the pandemic has increased the level of social isolation (167/195, 86%). Over half of these students (91/167, 54%) indicated that their overall interactions with other people such as friends had decreased significantly. In particular, about one-third (52/167, 31%) shared their worries about a lack of in-person interactions such as face-to-face meetings. Others (9/167, 5%) stated that disruptions to their outdoor activities (eg, jogging, hiking) have affected their mental health.

Concerns About Academic Performance

A majority of participants (159/195, 82%) showed concerns about their academic performance being impacted by the pandemic. The biggest perceived challenge was the transition to online classes (61/159, 38%). In particular, participants stated their concerns about sudden changes in the syllabus, the quality of the classes, technical issues with online applications, and the difficulty of learning online. Many participants (36/159, 23%) were worried about progress in research and class projects because of restrictions put in place to keep social distancing and the lack of physical interactions with other students. Some participants (23/159, 14%) mentioned the uncertainty about their grades under the online learning environment to be a major stressor. Others (12/159, 8%) indicated their reduced motivation to learn and tendency to procrastinate.

Disruptions to Eating Patterns

COVID-19 has also negatively impacted a large portion of participants’ dietary patterns (137/195, 70%). Many (35/137, 26%) stated that the amount of eating has increased, including having more snacks since healthy dietary options were reduced, and others (27/137, 20%) addressed that their eating patterns have become inconsistent because of COVID-19, for example, irregular times of eating and skipping meals. Some students (16/137, 12%) reported decreased appetite, whereas others (7/137, 5%) were experiencing emotional eating or a tendency to eat when bored. On the other hand, some students (28/195, 14%) reported that they were having healthier diets, as they were cooking at home and not eating out as much as they used to.

Changes in the Living Environment

A large portion of the participants (130/195, 67%) described that the pandemic has resulted in significant changes in their living conditions. A majority of these students (89/130, 68%) referred to living with family members as being less independent and the environment to be more distractive. For those who stayed in their residence either on- or off-campus (18/130, 14%), a main change in their living environment was reduced personal interactions with roommates. Some (9/130, 7%) mentioned that staying inside longer due to self-quarantine or shelter-in-place orders was a primary change in their living circumstances.

Financial Difficulties

More than half of the participants (115/195, 59%) expressed their concerns about their financial situations being impacted by COVID-19. Many (44/115, 38%) noted that COVID-19 has impacted or is likely to impact their own current and future employment opportunities such as part-time jobs and internships. Some (21/115, 18%) revealed the financial difficulties of their family members, mostly parents, getting laid off or receiving pay cuts in the wake of COVID-19.

Increased Class Workload

The effect of COVID-19 on class workload among the college students was not conclusive. Although slightly over half of participants (106/195, 54%) indicated their academic workload has increased due to COVID-19, the rest stated the workload has remained the same (70/195, 36%) or rather decreased (19/195, 10%). For those who were experiencing increased workloads, nearly half (51/106, 48%) thought they needed to increase their own efforts to catch up with online classes and class projects given the lack of in-person support from instructors or teaching assistants. About one-third of the participants (33/106, 31%) perceived that assignments had increased or became harder to do. Some (6/106, 6%) found that covering the remainder of coursework as the classes resumed after the 2-week break to be challenging.

Depressive Thoughts

When asked about the impact of the COVID-19 pandemic on depressive thoughts, 44% (86/195) mentioned that they were experiencing some depressive thoughts during the COVID-19 pandemic. Major contributors to such depressive thoughts were loneliness (28/86, 33%), insecurity or uncertainty (10/86, 12%), powerlessness or hopelessness (9/86, 10%), concerns about academic performance (7/86, 8%), and overthinking (4/86, 5%).

Suicidal Thoughts

Out of 195 participants, 16 (8%) stated that the pandemic has led to some suicidal thoughts with 5% (10/16) reporting these thoughts as mild and 3% (6/16) as moderate. There were 6 participants (38%) that attributed their suicidal thoughts to the presence of depressive thoughts. Other reasons were related to academic performance (1/16, 6%), problems with family as they returned home (1/16, 6%), and fear from insecurity and uncertainty (1/16, 6%).

Coping Mechanism During COVID-19

To cope with stress and anxiety imposed by COVID-19, college students reported seeking support from others but were mainly using various self-management methods.

Self-Management

The majority of the participants (105/138, 76%) with increased stress due to the outbreak of COVID-19 explained that they were using various means to help themselves cope with stress and anxiety during the pandemic. Some (24/105, 23%) relied on negative coping methods such as ignoring the news about COVID-19 (10/105), sleeping longer (7/105), distracting themselves by doing other tasks (5/105), and drinking or smoking (2/105). Approximately one-third (30/105, 29%) used positive coping methods such as meditation and breathing exercises (18/105), spiritual measures (7/105), keeping routines (4/105), and positive reframing (2/105). A majority of the participants (73/105, 70%) who used self-management mentioned doing relaxing hobbies including physical exercise (31/105), enjoying streaming services and social media (22/105), playing with pets (7/105), journaling (5/105), listening to music (4/105), reading (2/105), and drawing (2/105). Finally, some participants (15/105, 14%) stated that they were planning activities (eg, drafting to-do lists) for academic work and personal matters as a self-distraction method.

Seeking Support From Others

Approximately one-third of the participants (47/138, 34%) mentioned that communicating with their families and friends was a primary way to deal with stress and anxiety during COVID-19. Some explicitly stated that they were using a virtual meeting application such as Zoom frequently to connect to friends and family. Only 1 participant claimed to be receiving support from a professional therapist, and another participant was using Sanvello, a mobile mental health service app provided by the university.

Barriers to Seeking Professional Support During COVID-19

Despite the availability of tele-counseling and widespread promotion of such services by the university, a vast majority of participants who indicated an increase in stress and anxiety (128/138, 93%) claimed that they had not used school counseling services during the pandemic. Reasons for such low use included the condition not being perceived as severe enough to seek the services (4/128, 3%), not comfortable interacting with unfamiliar people (1/128, 0.8%), not comfortable talking about mental health issues over the phone (1/128, 0.8%), and lack of trust in the counseling services (1/128, 0.8%).

Principal Findings

College students comprise a population that is considered particularly vulnerable to mental health concerns. The findings of this study bring into focus the effects of pandemic-related transitions on the mental health and well-being of this specific population. Our findings suggest a considerable negative impact of the COVID-19 pandemic on a variety of academic-, health-, and lifestyle-related outcomes. By conducting online survey interviews in the midst of the pandemic, we found that a majority of the participants were experiencing increased stress and anxiety due to COVID-19. In addition, results of the PSS showed moderate levels of stress among our participants. This is in line with a recent pre–COVID-19 survey conducted in the United Kingdom (mean PSS score 19.79, SD 6.37) [ 28 ]; however, the administration of PSS as interview questions (compared to allowing participants to read and respond to the 10 questions) might have introduced bias and resulted in underreporting.

Among the effects of the pandemic identified, the most prominent was worries about one’s own health and the health of loved ones, followed by difficulty concentrating. These findings are in line with recent studies in China that also found concerns relating to health of oneself and of family members being highly prevalent among the general population during the pandemic. Difficulty in concentrating, frequently expressed by our participants, has previously been shown to adversely affect students’ confidence in themselves [ 29 ], which has known correlations to increased stress and mental health [ 30 ]. In comparison with stress and anxiety in college students’ general life, it appears that countermeasures put in place against COVID-19, such as shelter-in-place orders and social distancing practices, may have underpinned significant changes in students’ lives. For example, a vast majority of the participants noted changes in social relationships, largely due to limited physical interactions with their families and friends. This is similar to recent findings of deteriorated mental health status among Chinese students [ 10 ] and increased internet search queries on negative thoughts in the United States [ 31 ]. The findings on the impact of the pandemic on sleeping and eating habits are also a cause for concern, as these variables have known correlations with depressive symptoms and anxiety [ 20 ].

Although a majority of participants expressed concerns regarding academic performance, interestingly, almost half of the participants reported lower stress levels related to academic pressure and class workload since the pandemic began. This may be due, in part, to decisions taken by professors and the university to ease the students’ sudden transition to distance learning. For instance, this university allowed students to choose a pass/fail option for each course instead of a regular letter grade. Additionally, actions taken by professors, such as reduced course loads, open book examinations, and other allowances on grading requirements, could also have contributed to alleviating or reducing stress. Although participants who returned to their parental home reported concerns about distractions and independence, students might have benefited from family support and reduced social responsibilities. Therefore, the increased stress due to the pandemic may have been offset, at least to some extent.

Alarmingly, 44% (86/195) of the participants reported experiencing an increased level of depressive thoughts, and 8% (16/195) reported having suicidal thoughts associated with the COVID-19 pandemic. Previous research [ 32 ] reported about 3%-7% of the college student population to have suicidal thoughts outside of the pandemic situation. Furthermore, with the exception of high-burnout categories, depression levels among students, reported in several recent studies [ 33 - 35 ], have varied between 29% and 38%, which may suggest an uptick in pandemic-related depressive symptoms among college students similar to recent studies in China [ 10 , 11 ]. Although our participants specifically mentioned several factors such as feelings of loneliness, powerlessness, as well as financial and academic uncertainties, other outcomes that were perceived to be impacted by the COVID-19 pandemic may also act as contributors to depressive thoughts and suicidal ideation. In particular, both difficulty concentrating and changes in sleeping habits are associated with depression [ 20 , 29 , 36 ].

Our study also identifies several coping mechanisms varying between adaptive and maladaptive behaviors. The maladaptive coping behaviors such as denial and disengagement have been shown to be significant predictors of depression among young adults [ 37 ]. In contrast, adaptive coping such as acceptance and proactive behaviors are known to positively impact mental health. Our findings suggest that the majority of our participants exhibited maladaptive coping behaviors. Identifying students’ coping behavior is important to inform the planning and design of support systems. In this regard, participatory models of intervention development can be used, in which researchers’ and psychologists’ engagement with the target population to adapt interventional programs to their specific context has shown promise [ 37 , 38 ]. For instance, Nastasi et al [ 37 ] used a participatory model to develop culture-specific mental health services for high school students in Sri Lanka. Similar approaches can be adopted to engage college students as well to develop a mental health program that leverages their natural positive coping behaviors and addresses their specific challenges.

Participants described several barriers to seeking help, such as lack of trust in counseling services and low comfort levels in sharing mental health issues with others, which may be indicative of stigma. Perceiving social stigma as a barrier to seeking help and availing counseling services and other support is common among students [ 29 ]. One study showed that only a minor fraction of students who screened positive for a mental health problem actually sought help [ 39 ]. Although overcoming the stigma associated with mental health has been discussed at length, practical ways of mitigating this societal challenge remains a gap [ 40 , 41 ]. Our findings suggest that self-management is preferred by students and should be supported in future work. Digital technologies and telehealth applications have shown some promise to enable self-management of mental health issues [ 42 ]. For instance, Youn et al [ 43 ] successfully used social media networks as a means to reach out to college students and screen for depression by administering a standardized scale, the Patient Health Questionnaire-9. Digital web-based platforms have also been proposed to enhance awareness and communication with care providers to reduce stigma related to mental health among children in underserved communities [ 44 ]. For instance, one of the online modules suggested by the authors involves providing information on community-identified barriers to communicating with care providers. Technologies such as mobile apps and smart wearable sensors can also be leveraged to enable self-management and communication with caregivers.

In light of the aforementioned projections of continued COVID-19 cases at the time of this writing [ 45 ] and our findings, there is a need for immediate attention to and support for students and other vulnerable groups who have mental health issues [ 17 ]. As suggested by a recent study [ 46 ] based on the Italian experience of this pandemic, it is essential to assess the population’s stress levels and psychosocial adjustment to plan for necessary support mechanisms, especially during the recovery phase, as well as for similar events in the future. Although the COVID-19 pandemic seems to have resulted in a widespread forced adoption of telehealth services to deliver psychiatric and mental health support, more research is needed to investigate use beyond COVID-19 as well as to improve preparedness for rapid virtualization of psychiatric counseling or tele-psychiatry [ 47 - 49 ].

Limitations and Future Work

To our knowledge, this is the first effort in documenting the psychological impacts of the COVID-19 pandemic on a representative sample of college students in the United States via a virtual interview survey method in the middle of the pandemic. However, several limitations should be noted. First, the sample size for our interview survey was relatively small compared to typical survey-only studies; however, the survey interview approach affords the capture of elaboration and additional clarifying details, and therefore complements the survey-based approaches of prior studies focusing on student mental health during this pandemic [ 10 , 11 , 50 ]. Second, the sample used is from one large university, and findings may not generalize to all college students. However, given the nationwide similarities in universities transitioning to virtual classes and similar stay-at-home orders, we expect reasonable generalizability of these findings. Additionally, a majority of our participants were from engineering majors. Therefore, future work is needed to use a stratified nationwide sample across wider disciplines to verify and amend these findings. Third, although a vast majority of participants answered that they have not used the university counseling service during the pandemic, only a few of them provided reasons. Since finding specific reasons behind the low use is a key to increasing college students’ uptake of available counseling support, future research is warranted to unveil underlying factors that hinder college students’ access to mental health support. Finally, we did not analyze how student mental health problems differ by demographic characteristics (eg, age, gender, academic year, major) or other personal and social contexts (eg, income, religion, use of substances).

Future work could focus on more deeply probing the relationships between various coping mechanisms and stressors. Additionally, further study is needed to determine the effects of the pandemic on students’ mental health and well-being in its later phases beyond the peak period. As seen in the case of health care workers in the aftermath of the severe acute respiratory syndrome outbreak, there is a possibility that the effects of the pandemic on students may linger for a period beyond the peak of the COVID-19 pandemic itself [ 51 ].

Acknowledgments

This research was partly funded by a Texas A&M University President’s Excellence (X-Grant) award.

Conflicts of Interest

None declared.

• Unger K. Handbook on Supported Education: Providing Services for Students With Psychiatric Disabilities. Charleston, SC: BookSurge Publishing; 2007.
• 2019 annual report. Center for Collegiate Mental Health. University Park, PA: Penn State University; 2020.   URL: https://ccmh.memberclicks.net/assets/docs/2019-CCMH-Annual-Report_3.17.20.pdf [accessed 2020-05-11]
• Shuchman M. Falling through the cracks — Virginia Tech and the restructuring of college mental health services. N Engl J Med 2007 Jul 12;357(2):105-110. [ CrossRef ]
• Eisenberg D, Downs MF, Golberstein E, Zivin K. Stigma and help seeking for mental health among college students. Med Care Res Rev 2009 Oct;66(5):522-541. [ CrossRef ] [ Medline ]
• Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020 Mar 14;395(10227):912-920 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 2020 Mar 02;3(3):e203976 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA Pediatr 2020 Apr 24:e201619 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Kirzinger A, Kearney A, Hamel L, Brodie M. KFF health tracking poll - early April 2020: the impact Of coronavirus on life In America. Kaiser Family Foundation. 2020 Apr 02.   URL: https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/ [accessed 2020-05-10]
• Nelson B, Pettitt A, Flannery J, Allen N. Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample. Int J Methods in Psychiatr Res 2020 Apr 13;21(3):169-184. [ CrossRef ]
• Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020 May;287:112934 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Liu X, Liu J, Zhong X. Psychological state of college students during COVID-19 epidemic. SSRN J 2020 Mar 24:A. [ CrossRef ]
• Wang C, Zhao H. The impact of COVID-19 on anxiety in Chinese university students. Front Psychol 2020;11:1168. [ CrossRef ] [ Medline ]
• Bruffaerts R, Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K, et al. Mental health problems in college freshmen: prevalence and academic functioning. J Affect Disord 2018 Jan 01;225:97-103 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zhai Y, Du X. Addressing collegiate mental health amid COVID-19 pandemic. Psychiatry Res 2020 Jun;288:113003 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zhai Y, Du X. Mental health care for international Chinese students affected by the COVID-19 outbreak. Lancet Psychiatry 2020 Apr;7(4):e22 [ FREE Full text ] [ CrossRef ] [ Medline ]
• de Oliveira Araújo FJ, de Lima LSA, Cidade PIM, Nobre CB, Neto MLR. Impact of Sars-Cov-2 and its reverberation in global higher education and mental health. Psychiatry Res 2020 Jun;288:112977 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry 2020 Jun;7(6):547-560 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983 Dec;24(4):385-396. [ Medline ]
• Cohen S, Kessler R, Gordon L. Measuring stress: A Guide for Health and Social Scientists. New York, NY: Oxford University Press; 1997.
• Acharya L, Jin L, Collins W. College life is stressful today - emerging stressors and depressive symptoms in college students. J Am Coll Health 2018 Oct;66(7):655-664. [ CrossRef ] [ Medline ]
• Baghurst T, Kelley BC. An examination of stress in college students over the course of a semester. Health Promot Pract 2014 May;15(3):438-447. [ CrossRef ] [ Medline ]
• Zoom. Zoom Video Communications.   URL: https://zoom.us/
• Otter.ai.   URL: https://otter.ai/login
• Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol 2006 Jan;3(2):77-101. [ CrossRef ]
• Guest G, MacQueen K, Namey E. Applied Thematic Analysis. Thousand Oaks, CA: Sage Publications; 2011.
• Corbin J, Strauss A. Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory. Thousand Oaks, CA: Sage Publications; 2014.
• MAXQDA. VERBI Software.   URL: https://www.maxqda.com/
• Denovan A, Dagnall N, Dhingra K, Grogan S. Evaluating the perceived stress scale among UK university students: implications for stress measurement and management. Stud Higher Education 2017 Jun 22;44(1):120-133. [ CrossRef ]
• Martin JM. Stigma and student mental health in higher education. Higher Education Res Dev 2010 Jun;29(3):259-274. [ CrossRef ]
• Zuckerman DM. Stress, self-esteem, and mental health: how does gender make a difference? Sex Roles 1989 Apr;20(7-8):429-444. [ CrossRef ]
• Jacobson NC, Lekkas D, Price G, Heinz MV, Song M, O'Malley AJ, et al. Flattening the mental health curve: COVID-19 stay-at-home orders are associated with alterations in mental health search behavior in the United States. JMIR Ment Health 2020 Jun 01;7(6):e19347 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. J Affect Disord 2009 Oct;117(3):180-185. [ CrossRef ] [ Medline ]
• Zeng Y, Wang G, Xie C, Hu X, Reinhardt JD. Prevalence and correlates of depression, anxiety and symptoms of stress in vocational college nursing students from Sichuan, China: a cross-sectional study. Psychol Health Med 2019 Aug;24(7):798-811. [ CrossRef ] [ Medline ]
• Nahas ARMF, Elkalmi R, Al-Shami A, Elsayed T. Prevalence of depression among health sciences students: findings from a public university in Malaysia. J Pharm Bioallied Sci 2019;11(2):170-175 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Fitzpatrick O, Biesma R, Conroy RM, McGarvey A. Prevalence and relationship between burnout and depression in our future doctors: a cross-sectional study in a cohort of preclinical and clinical medical students in Ireland. BMJ Open 2019 May 01;9(4):e023297 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Heiligenstein E, Guenther G, Hsu K, Herman K. Depression and academic impairment in college students. J Am Coll Health 1996 Sep;45(2):59-64. [ CrossRef ] [ Medline ]
• Nastasi BK, Sarkar S, Varjas K, Jayasena A. Participatory model of mental health programming: lessons learned from work in a developing country. Sch Psychol Rev 1998;27(2):260-276.
• Cappella E, Jackson DR, Bilal C, Hamre BK, Soulé C. Bridging mental health and education in urban elementary schools: participatory research to inform intervention development. Sch Psychol Rev 2011;40(4):486-508.
• Eisenberg D, Hunt J, Speer N, Zivin K. Mental health service utilization among college students in the United States. J Nerv Ment Dis 2011 May;199(5):301-308. [ CrossRef ] [ Medline ]
• Husain W. Barriers in seeking psychological help: public perception in Pakistan. Community Ment Health J 2020 Jan;56(1):75-78. [ CrossRef ] [ Medline ]
• Fischer EP, McSweeney JC, Wright P, Cheney A, Curran GM, Henderson K, et al. Overcoming barriers to sustained engagement in mental health care: perspectives of rural veterans and providers. J Rural Health 2016 Sep;32(4):429-438. [ CrossRef ] [ Medline ]
• Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. Digital mental health and COVID-19: using technology today to accelerate the curve on access and quality tomorrow. JMIR Ment Health 2020 Mar 26;7(3):e18848 [ FREE Full text ] [ CrossRef ] [ Medline ]
• Youn SJ, Trinh N, Shyu I, Chang T, Fava M, Kvedar J, et al. Using online social media, Facebook, in screening for major depressive disorder among college students. Int J Clin Health Psychol 2013 Jan;13(1):74-80. [ CrossRef ]
• Ginossar T, Nelson S. Reducing the health and digital divides: a model for using community-based participatory research approach to e-health interventions in low-income Hispanic communities. J Computer-Mediated Commun 2010;15(4):530-551. [ CrossRef ]
• COVID-19 projections. Institute for Health Metrics and Evaluation. Seattle, WA: University of Washington   URL: https://covid19.healthdata.org/united-states-of-america [accessed 2020-05-20]
• de Girolamo G, Cerveri G, Clerici M, Monzani E, Spinogatti F, Starace F, et al. Mental health in the coronavirus disease 2019 emergency-the Italian response. JAMA Psychiatry 2020 Apr 30:A. [ CrossRef ] [ Medline ]
• Zhou J, Liu L, Xue P, Yang X, Tang X. Mental health response to the COVID-19 outbreak in China. Am J Psychiatry 2020 Jul 01;177(7):574-575. [ CrossRef ] [ Medline ]
• Zhou X, Snoswell CL, Harding LE, Bambling M, Edirippulige S, Bai X, et al. The role of telehealth in reducing the mental health burden from COVID-19. Telemed J E Health 2020 Apr;26(4):377-379. [ CrossRef ] [ Medline ]
• Shore JH, Waugh M, Calderone J, Donahue A, Rodriguez J, Peters D, et al. Evaluation of telepsychiatry-enabled perinatal integrated care. Psychiatr Serv 2020 May 01;71(5):427-432. [ CrossRef ] [ Medline ]
• Huckins JF, daSilva AW, Wang W, Hedlund E, Rogers C, Nepal SK, et al. Mental health and behavior of college students during the early phases of the COVID-19 pandemic: longitudinal smartphone and ecological momentary assessment study. J Med Internet Res 2020 Jun 17;22(6):e20185 [ FREE Full text ] [ CrossRef ] [ Medline ]
• McAlonan GM, Lee AM, Cheung V, Cheung C, Tsang KW, Sham PC, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry 2007 Apr;52(4):241-247. [ CrossRef ] [ Medline ]

Abbreviations

Edited by G Eysenbach, G Fagherazzi, J Torous; submitted 10.06.20; peer-reviewed by T Liu, V Hagger; comments to author 28.07.20; revised version received 01.08.20; accepted 15.08.20; published 03.09.20

©Changwon Son, Sudeep Hegde, Alec Smith, Xiaomei Wang, Farzan Sasangohar. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 03.09.2020.

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• Volume 10, Issue 12
• Impact of the COVID-19 pandemic on mental health and well-being of communities: an exploratory qualitative study protocol
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• http://orcid.org/0000-0003-0180-0213 Anam Shahil Feroz 1 , 2 ,
• Naureen Akber Ali 3 ,
• Noshaba Akber Ali 1 ,
• Ridah Feroz 4 ,
• Salima Nazim Meghani 1 ,
• Sarah Saleem 1
• 1 Community Health Sciences , Aga Khan University , Karachi , Pakistan
• 2 Institute of Health Policy, Management and Evaluation , University of Toronto , Toronto , Ontario , Canada
• 3 School of Nursing and Midwifery , Aga Khan University , Karachi , Pakistan
• 4 Aga Khan University Institute for Educational Development , Karachi , Pakistan
• Correspondence to Ms Anam Shahil Feroz; anam.sahyl{at}gmail.com

Introduction The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. In addition, with the widespread use of social media, rumours, myths and inaccurate information about the virus are spreading rapidly, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes of community members towards COVID-19 and its impact on their daily lives and mental well-being.

Methods and analysis This formative research will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews with community members. The study will be conducted in the Karimabad Federal B Area and in the Garden (East and West) community settings in Karachi, Pakistan. The community members of these areas have been selected purposively for the interview. Study data will be analysed thematically using NVivo V.12 Plus software.

Ethics and dissemination Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The results of the study will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

• mental health
• public health

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https://doi.org/10.1136/bmjopen-2020-041641

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Strengths and limitations of this study

The mental health impact of the COVID-19 pandemic is likely to last much longer than the physical health impact, and this study is positioned well to explore the perceptions and attitudes of community members towards the pandemic and its impact on their daily lives and mental well-being.

This study will guide the development of context-specific innovative mental health programmes to support communities in the future.

One limitation is that to minimise the risk of infection all study respondents will be interviewed online over Zoom and hence the authors will not have the opportunity to build rapport with the respondents or obtain non-verbal cues during interviews.

The COVID-19 pandemic has affected almost 180 countries since it was first detected in Wuhan, China in December 2019. 1 2 The COVID-19 outbreak has been declared a public health emergency of international concern by the WHO. 3 The WHO estimates the global mortality to be about 3.4% 4 ; however, death rates vary between countries and across age groups. 5 In Pakistan, a total of 10 880 cases and 228 deaths due to COVID-19 infection have been reported to date. 6

The worldwide COVID-19 pandemic has not only incurred massive challenges to the global supply chains and healthcare systems but also has a detrimental effect on the overall health of individuals. 7 The pandemic has led to lockdowns and has created destructive impact on the societies at large. Most company employees, including daily wage workers, have been prohibited from going to their workplaces or have been asked to work from home, which has caused job-related insecurities and financial crises in the communities. 8 Educational institutions and training centres have also been closed, which resulted in children losing their routine of going to schools, studying and socialising with their peers. Delay in examinations is likewise a huge stressor for students. 8 Alongside this, parents have been struggling with creating a structured milieu for their children. 9 COVID-19 has hindered the normal routine life of every individual, be it children, teenagers, adults or the elderly. The crisis is engendering burden throughout populations and communities, particularly in developing countries such as Pakistan which face major challenges due to fragile healthcare systems and poor economic structures. 10

The COVID-19 pandemic has certainly resulted in an increased level of anxiety and fear in communities in terms of disease management and infection spread. 8 Further, the highly contagious nature of COVID-19 has also escalated confusion, fear and panic among community residents. Moreover, social distancing is often an unpleasant experience for community members and for patients as it adds to mental suffering, particularly in the local setting where get-togethers with friends and families are a major source of entertainment. 9 Recent studies also showed that individuals who are following social distancing rules experience loneliness, causing a substantial level of distress in the form of anxiety, stress, anger, misperception and post-traumatic stress symptoms. 8 11 Separation from family members, loss of autonomy, insecurity over disease status, inadequate supplies, inadequate information, financial loss, frustration, stigma and boredom are all major stressors that can create drastic impact on an individual’s life. 11 Due to fear and social stigma linked with COVID-19, many individuals in the community hide their disease and do not access healthcare facilities in a timely manner. 12 With the widespread use of social media, 13 rumours, myths and inaccurate information about COVID-19 are also spreading rapidly, not only among adults but are also carried on to children, leading to intensified irritability, fearfulness, insomnia, oppositional behaviours and somatic complaints. 9 The psychological symptoms associated with COVID-19 at the community level are also manifested as anxiety-driven panic buying, resulting in exhaustion of resources from the market. 14 Some level of panic also dwells in the community due to the unavailability of essential protective equipment, particularly masks and sanitisers. 15 Similarly, mental health issues, including depression, anxiety, panic attacks, psychotic symptoms and even suicide, were reported during the early severe acute respiratory syndrome outbreak. 16 17 COVID-19 is likely posing a similar risk throughout the world. 12

The fear of transmitting the disease or a family member falling ill is a probable mental function of human nature, but at some point the psychological fear of the disease generates more anxiety than the disease itself. Therefore, mental health problems are likely to increase among community residents during an epidemic situation. Considering the relevance of all these factors, we aim to explore the perceptions and attitudes towards COVID-19 among community residents and the impact of these perceptions and attitude on their daily lives and mental well-being.

Methods and analysis

Study design.

This study will employ an exploratory qualitative research design using semistructured interviews and a purposive sampling approach. The data collection methods for this formative research will include indepth interviews (IDIs) with community members. The IDIs aim to explore perceptions of community members towards COVID-19 and its impact on their mental well-being.

Study setting and study participants

The study will be conducted in two communities in Karachi City: Karimabad Federal B Area Block 3 Gulberg Town, and Garden East and Garden West. Karimabad is a neighbourhood in the Karachi Central District of Karachi, Pakistan, situated in the south of Gulberg Town bordering Liaquatabad, Gharibabad and Federal B Area. The population of this neighbourhood is predominantly Ismailis. People living here belong mostly to the middle class to the lower middle class. It is also known for its wholesale market of sports goods and stationery. Garden is an upmarket neighbourhood in the Karachi South District of Karachi, Pakistan, subdivided into two neighbourhoods: Garden East and Garden West. It is the residential area around the Karachi Zoological Gardens; hence, it is popularly known as the ‘Garden’ area. The population of Garden used to be primarily Ismailis and Goan Catholics but has seen an increasing number of Memons, Pashtuns and Baloch. These areas have been selected purposively because the few members of these communities are already known to one of the coinvestigators. The coinvestigator will serve as a gatekeeper for providing entrance to the community for the purpose of this study. Adult community members of different ages and both genders will be interviewed from both sites, as mentioned in table 1 . Interview participants will be selected following the eligibility criteria.

• View inline

Study participants for indepth interviews

IDIs with community members

We will conduct IDIs with community members to explore the perceptions and attitudes of community members towards COVID-19 and its effects on their daily lives and mental well-being. IDI participants will be identified via the community WhatsApp group, and will be invited for an interview via a WhatsApp message or email. Consent will be taken over email or WhatsApp before the interview begins, where they will agree that the interview can be audio-recorded and that written notes can be taken. The interviews will be conducted either in Urdu or in English language, and each interview will last around 40–50 min. Study participants will be assured that their information will remain confidential and that no identifying features will be mentioned on the transcript. The major themes will include a general discussion about participants’ knowledge and perceptions about the COVID-19 pandemic, perceptions on safety measures, and perceived challenges in the current situation and its impact on their mental well-being. We anticipate that 24–30 interviews will be conducted, but we will cease interviews once data saturation has been achieved. Data saturation is the point when no new themes emerge from the additional interviews. Data collection will occur concurrently with data analysis to determine data saturation point. The audio recordings will be transcribed by a transcriptionist within 24 hours of the interviews.

An interview guide for IDIs is shown in online supplemental annex 1 .

Supplemental material

Eligibility criteria.

The following are the criteria for inclusion and exclusion of study participants:

Inclusion criteria

Residents of Garden (East and West) and Karimabad Federal B Area of Karachi who have not contracted the disease.

Exclusion criteria

Those who refuse to participate in the study.

Those who have experienced COVID-19 and are undergoing treatment.

Those who are suspected for COVID-19 and have been isolated/quarantined.

Family members of COVID-19-positive cases.

Data collection procedure

A semistructured interview guide has been developed for community members. The initial questions on the guide will help to explore participants’ perceptions and attitudes towards COVID-19. Additional questions on the guide will assess the impact of these perceptions and attitude on the daily lives and mental health and well-being of community residents. All semistructured interviews will be conducted online via Zoom or WhatsApp. Interviews will be scheduled at the participant’s convenient day and time. Interviews are anticipated to begin on 1 December 2020.

Patient and public involvement

No patients were involved.

Data analysis

We will transcribe and translate collected data into English language by listening to the audio recordings in order to conduct a thematic analysis. NVivo V.12 Plus software will be used to import, organise and explore data for analysis. Two independent researchers will read the transcripts at various times to develop familiarity and clarification with the data. We will employ an iterative process which will help us to label data and generate new categories to identify emergent themes. The recorded text will be divided into shortened units and labelled as a ‘code’ without losing the main essence of the research study. Subsequently, codes will be analysed and merged into comparable categories. Lastly, the same categories will be grouped into subthemes and final themes. To ensure inter-rater reliability, two independent investigators will perform the coding, category creation and thematic analyses. Discrepancies between the two investigators will be resolved through consensus meetings to reduce researcher bias.

Ethics and dissemination

Study participants will be asked to provide informed, written consent prior to participation in the study. The informed consent form can be submitted by the participant via WhatsApp or email. Participants who are unable to write their names will be asked to provide a thumbprint to symbolise their consent to participate. Ethical approval for this study has been obtained from the Aga Khan University Ethical Review Committee (2020-4825-10599). The study results will be disseminated to the scientific community and to the research subjects participating in the study. The findings will help us explore the perceptions and attitudes of different community members towards the COVID-19 pandemic and its impact on their daily lives and mental well-being.

The findings of this study will help us to explore the perceptions and attitudes towards the COVID-19 pandemic and its impact on the daily lives and mental well-being of individuals in the community. Besides, an indepth understanding of the needs of the community will be identified, which will help us develop context-specific innovative mental health programmes to support communities in the future. The study will provide insights into how communities are managing their lives under such a difficult situation.

• World Health Organization
• Nielsen-Saines K , et al
• Worldometer
• Ebrahim SH ,
• Gozzer E , et al
• Snoswell CL ,
• Harding LE , et al
• Nargis Asad
• van Weel C ,
• Qidwai W , et al
• Brooks SK ,
• Webster RK ,
• Smith LE , et al
• Tripathy S ,
• Kar SK , et al
• Schwartz J ,
• Maunder R ,

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

ASF and NAA are joint first authors.

Contributors ASF and NAA conceived the study. ASF, NAA, RF, NA, SNM and SS contributed to the development of the study design and final protocols for sample selection and interviews. ASF and NAA contributed to writing the manuscript. All authors reviewed and approved the final version of the paper.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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A quantitative assessment of the views of mental health professionals on exercise for people with mental illness: perspectives from a low-resource setting

Davy vancampfort.

1 KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium

2 KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium

Robert Stanton

3 Central Queensland University, School of Health. Medical and Applied Sciences, North Rockhampton, Australia

Michel Probst

Marc de hert, ruud van winkel.

4 KU Leuven, Centre for Contexual Psychiatry, Leuven, Belgium

Inez Myin-Germeys

Eugene kinyanda.

5 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda

6 Department of Psychiatry, Makerere College of Health Sciences, Kampala, Uganda

7 Senior Wellcome Trust Fellowship, London

James Mugisha

8 Butabika National Referral Mental Hospital, Kampala, Uganda

9 Kyambogo University, Kampala, Uganda

Exercise is nowadays considered as an evidence-based treatment modality in people with mental illness. Nurses and occupational therapists working in low-resourced mental health settings are well-placed to provide exercise advice for people with mental illness.

We examined the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness, and identified perceived barriers to exercise prescription and exercise participation for people with mental illness.

In this study, 31 Ugandan health care professionals 20 men; 31.2 ± 7.1 years completed the Exercise in Mental Illness Questionnaire- Health Professionals Version EMIQ-HP.

The vast majority of the respondents 29/31, 94% reported they prescribed exercise at least “occasionally” to people with mental illness. Exercise-prescription parameters used were consistent with those recommended for people with mental illness. Regarding barriers to exercise participation, coping with side effects of psychotropic medication at the individual level and reducing stigma at community level should be prioritized.

A health care reform to enable collaboration with exercise professionals, such as exercise physiologists or physiotherapists, might increase exercise uptake for people with mental illness, thereby improving health outcomes for this vulnerable population.

Introduction

Mental illness is the leading cause of years lived with disability YLD in sub-Saharan Africa SSA, accounting for about one fifth of all disability-associated burden YLD 1 . It is estimated that the burden will more than double by 2050 Institute for Health Metrics and Evaluation, 2013. The consequences of the rising and devastating burden of mental illness is not only having an impact on the individual but also on the family and community as a whole. The quality of life of those affected is severely reduced and economic costs are significant 2 . Moreover, physical co-morbidities 3 , 4 , chronic pain 5 , 6 and HIV/AIDS 7 , 8 are more common in people with mental illness and add to the disability and burden. Despite this tremendous burden, most SSA countries invest less than 1% of the total health budget on mental health World Health Organization, 2011. As a result, mental health services are poorly resourced and considered inaccessible 9 . Therefore, it is not a surprise that treatment rates for people with mental disorders remain low, with less than 10% receiving mental health care 10 .

Despite significant efforts by the Ugandan Ministry of Health to improve access to mental health services 11 , treatment gaps remain, in part, due to the cultural beliefs and help-seeking behaviors of the Ugandan population, who often seek traditional medicine as first-line intervention, as opposed to Westernized care 9 . Community-based rehabilitation, psychoeducation and social support are recommended for low resource settings such as Uganda, with assertive community care and cognitive behavioral therapy recommended as additions in higher resourced settings with stronger service-delivery platforms 12 .

In recent years there has been an increasing interest in exercise as a stand-alone or complementary treatment modality for people with mental illnesses such as depression 13 , schizophrenia 14 , bipolar disorders 15 , alcohol use disorders 16 , post-traumatic stress disorder 17 and anxiety disorders 18 . Exercise supports patients in managing their psychiatric symptoms, andit improves the physical health and quality of life 19 . Since exercise may be implemented at low cost and often requires no or minimal resources and can be easily tailored to accommodate co-morbidities or injuries, it may be attractive in low resource settings. The potential role of exercise interventions however seems to be given low priority and to be neglected in these low resource settings 20 . This is not surprising since the emphasis in health service delivery in SSA is based on the biomedical model as opposed to the biopsychosocial model with an important focus on pharmacotherapy in the management of mental disorders Mugisha, 2016.

Although physio-therapists and exercise physiologists are ideally placed to deliver exercise interventions 21 – 24 , these clinical roles are currently not available in many low resource settings in SSA countries 20 . In clinical practice, the existing staff including mental health nurses, occupational therapists, psychologists, doctors and psychiatrists, are currently better placed to deliver exercise counseling for people with mental illness.Qualitative 25 and quantitative Stanton et al., 2015 a studies in high income countries suggest that nurses working in mental health settings acknowledge the value of exercise for people with mental illness and believe providing exercise advice is part of their role. However, such data is lacking in low resource settings, but are urgently needed in order to influence policy and practice and maximize access to the therapeutic potential of exercise at all levels of care. Such data may also help address personal factors including low confidence and limited training in exercise prescription 26 , and systemic barriers such as competing work priorities 27 , 28 that limit the provision of exercise programs for people with mental illness in low resource settings.

Therefore, in order to better inform the development of exercise interventions that can be implemented in low resource settings at all levels of care in and to define specific training needs, a comprehensive assessment of the current knowledge, attitudes, beliefs and behaviors of health practitioners working in mental health settings regarding the prescription of exercise for people with a mental illness is required. The aims of the present study are twofold. Firstly, to examine the current exercise prescription practices employed by Ugandan health care professionals when working with people with mental illness. Secondly, to identify perceived barriers to exercise prescription and perceived barriers to exercise participation for people with mental illness.

Study design

This was a cross-sectional study.

Study setting and procedure

This study was a cross-sectional investigation undertaken at Uganda's only psychiatric hospital, the Butabika National Referral Mental Hospital. The nurses and occupation therapists working in two adult long-term care units were invited to participate. Combined, these two units could accommodate 110 in-patients and employs 32 nurses and 2 occupational therapists. First, all the nurses and occupational therapists were provided with an information sheet outlining the purpose of the study and with the questionnaire. The information sheet and questionnaire were provided by a research nurse who was not working in the two adult long-term care units. There were no exclusion criteria. The information sheet stated that the research nurse was available upon request to assist in the completion of the questionnaire. After one month, the research nurse gave a one-time reminder to the staff members who volunteered to participate, to complete the questionnaire within the following month. A self-administered questionnaire were used to collect data since the participants were fluent and competent in English. Content validity, conceptual equivalence and cultural sensitivity were also not an issue. No incentive for completion of the survey was offered. Participation was anonymous with questionnaires placed in a sealed box not observable to other staff members. Informed consent was assumed on completion and return of the survey. Data were collected during November and December, 2017. Ethical clearance for the study was received from the local Butabika Hospital Research Committee.

Study instrument

Participants completed the Exercise in Mental Illness Questionnaire- Health Professionals Version EMIQ-HP for which content validity and test-retest reliability have previously been established 29 . The instrument comprises six domains of exercise knowledge, exercise beliefs, exercise prescription behaviors, barriers to exercise, personal exercise habits and demographics. Time to complete the paper-based survey was approximately 20 minutes. Exercise-prescription practices were determined using the question; “Do you prescribe exercise to people with a mental illness?” with four response options of: “Never”, “Occasionally”, “Most of the time” and “Always”. Self-rated knowledge and confidence to prescribe exercise for people with mental illness were assessed using Likert-response questions, 1 = “Very poor”, and 5 = “Excellent”. To examine the views of other well-established treatment strategies for mental illness, respondents were asked to rate how valuable they believed each treatment was, compared to exercise, using a five-point Likert scale where 1 = “Significantly less than exercise”, and 5 = “Significantly better than exercise”. Electroconvulsive therapy and bright light therapy were removed from the list of well-established treatments, as they are not practiced in the setting we investigated. Respondents then answered questions regarding strategies used to prescribe exercise including the frequency, intensity, duration, and type of exercise duration, frequency, using fixed response options. Level of agreement questions using a five-point Likertscale with anchors from 1 = “Strongly disagree” to5 = “Strongly agree” were used to examine respondents' views regarding barriers to exercise prescription for people with mental illness, and exercise participation by people with mental illness. Future training needs were examined with respect to level and topics of interest for professional development. Responses to statements for each subsection were then summed, thus a higher score indicates a higher level of agreement. Finally, the following demographic data were captured as part of the EMIQ-HP: gender male / female, age years, current marital status married or not married, years in profession, and full time employment yes or no.

Statistical analysis

Participant demographics, exercise prescription practices and responses to statements regarding barriers to exercise prescription for; and barriers to exercise participation by people with mental illness are reported using descriptive statistics mean ± SD, frequencies. In accordance with previous studies 29 , 30 , responses to statements were collapsed to three categories; “Agree”, “Neutral”, and “Disagree”. Since the Likert scale responses are not assumed to be on an equal interval scale, and frequency of responses to “Strongly agree” and “Agree” are low, these responses were collapsed to “Agree”. Based on rating scale optimization, collapsing the positive responses “Strongly agree” and “Agree” into one category is logical and does not create an artificial new category. Similarly, combining negative responses “Strongly disagree” and “Disagree” demonstrates the strength of these responses, compared to neutral and positive responses 31 .

Participants

Thirty-one health care professionals, representing 91% of potential respondents completed the EMIQ-HP. Respondents included 10 nurses, 19 nurses with specialist mental health nursing qualification and 2 occupational therapists. The characteristics of respondents are shown in Table 1 .

Demographic characteristics of respondents n=31

Frequency of exercise prescription

Three respondents 10% reported ‘Always’ prescribing exercise, 3 (10%) reported prescribing exercise ‘Most of the time’, 23 (74%) reported prescribing exercise ‘Occasionally’ and two 6% reported ‘Never’ prescribing exercise.

Knowledge about and confidence regarding exercise prescription

Sixteen respondents (52%) indicated that they had a formal training in exercise prescription. The mean ±SD response for self-reported knowledge and confidence scores was3.6± 0.6 and 3.6±0.5, respectively. Nine respondents 29% reported a “Good” or “Excellent” knowledge of exercise prescription for mental illness. Similarly, 10 respondents (32%) reported that they are confident at prescribing exercise for people with mental illness to be ''Good” or “Excellent”.

Views of health care professionals comparing established treatments to exercise for the treatment of mental illness

Overall, between 74% and 90% of respondents believed other treatment modalities to be of equal or greater value compared to exercise. The majority of respondents n=24, 77% believed medication is ‘Somewhat’, or ‘Significantly’ more valuable than exercise. Between 45% and 65% of respondents believed other treatment modalities are ‘Somewhat’, or ‘Significantly’ more valuable than exercise. Slightly more than one-third n=11, 35% of respondents believed social skills training is of equal value to exercise. A summary of the findings regarding the value to treatments compared to exercise is shown in Table 2 .

Comparison of established treatments to exercise for the treatment of mental illness

Exercise prescription strategies

When considering the strategies used to prescribe exercise to people with mental illness, personal discussion, including the development of an individualized program was the most frequently used strategy n=19/29, 65%. Only one respondent indicated referral to an exercise physiologist / physiotherapist for exercise prescription. The most commonly reported recommendation for exercise frequency was to exercise “As often as they can” n=12/29, 41% followed by on “Most days of the week” n=10/29, 34%. The most frequently recommended exercise intensity for people with mental illness was “At a level that makes them feel good” n=9/29, 31%, followed by “Moderate” n=7/29, 24%. “30 minutes per day'' n=11/29, 38% was the most frequently prescribed exercise duration followed by “Exercising as long as they can” n=7/29, 24%. Relaxation exercises such as yoga or Tai Chi n=16/29, 55% were the most commonly prescribed mode of exercise followed by aerobic exercise n=10/29, 34%.

Barriers to exercise prescription

Responses to statements regarding the barriers to exercise prescription for people with mental illness are shown in Table 3 . When collapsed to categories of ‘Agree’, ‘Neutral’, and ‘Disagree’, just over half n=18, 58% agreed that patient's mental health makes it impossible for them to participate in exercise. Almost half n=13, 45% agreed that getting injured during exercise is a concern. Overwhelmingly however, 87% of respondents n=27 agreed that exercise will be beneficial, and were interested in exercise prescription for this population. Only 13% n=4 agreed that exercise prescription is not part of their job, but 16% agreed that they did not know how to prescribe exercise for people with mental illness. Importantly, 71% n=22 agreed that exercise prescription for people with mental illness is best delivered by an exercise professional.

Level of agreement [n %] with statements regarding barriers to exercise prescription for people with mental illness

Barriers to participation

The agreement with statements expressed by people with mental illness regarding exercise participation is shown in Table 4. In a manner similar to the responses to statements regarding barriers to exercise prescription, scale optimization was performed to result in three categories. When collapsed to categories of “Agree”, “Neutral”, and “Disagree”, almost three-quarters of respondents n=23, 74% agreed with the consumer view that “There is too much stigma attached to having a mental illness.” while more than half n=18, 58% agreed with the statement “There are too many side effects from the medications.”

Training needs for health care professionals

Participants were cognizant of the need for ongoing professional development in the field. More than two-thirds of respondents 23/31 indicated they would “Definitely” attend further training for exercise prescription for people with mental illness, with the most commonly reported topics of interest being “How to assess the patients' suitability for physical activity?” n=22, 71% and “How to get and maintain motivation in people with mental illness?” n=18, 58%.

General findings

The present study is the first to provide new insight from the perspectives of health professionals working in a long-term adult inpatient mental health facility in a low resource country, with regard to the prescription of exercise to people with mental illness. The 31 respondents in the present survey represent approximately 90% of the health care professionals working in the mental health setting explored.

The vast majority 29/31, 94% reported that they prescribed at least “occasionally” exercise to their patients. The positive attitude of nurses and occupational therapists towards exercise is in line with previous research in other parts of the world. For example, a British study 32 reported that 77% of mental health nurses felt that providing exercise advice and referring to a community facility was part of their role while in an Australian study Stanton et al. 33 , 2015b 72% of the nurses reported prescribing exercise to mental health consumers.

Participants self-reported a high level of knowledge and confidence in prescribing exercise for people with mental illness. This high level of knowledge is also reflected in the exercise-prescription parameters for exercise frequency, intensity, duration, and type recommended by respondents. These are consistent with those recommended for people with mental illness 33 , 34 . International guidelines call for aerobic exercise to be performed 3 to 5 days per week for 30 min at low-to-moderate or self-selected intensity 33 , 34 . The popular view regarding exercising at a level that makes them feel good, and for as long as they like, is consistent with the use of autonomous regulation in exercise prescription for people with mental illness 35 – 37 and consistent with approaches used in other health professional groups 38 , 39 .

The high level of knowledge and confidence in prescribing exercise for people with mental illness is perhaps unsurprising given that more than half of the existing work staff indicated that they are trained in exercise prescription and implementing lifestyle interventions for people with chronic or complex health conditions, a rate which is for example much higher than in Australia where only 11% of the nurses reported having any formal training in exercise prescription 38 . Since Butabika Hospital is a national referral hospital, many of its staff are likely also more exposed to information related to exercise compared to work staff in more rural areas, owing to the fact that the hospital runs a bigger budget, from both local resources and donors for continued medical education 27 , 28 . On the other hand, almost 75% of the respondents indicated that they would “definitely” attend further training for exercise prescription for people with mentalillness, in particular related to how to assess patients and how to motivate them towards an active lifestyle. More than seventy percent of the participants also reported that exercise to people with mental illness is actually best delivered by an exercise professional, although only one respondent referred patients to such an exercise professional. A potential reason for the very low referral rate is the lack of exercise specialists working in mental health care settings in low income countries 20 . It is likely that due to the strong biomedical focus on pharmacotherapy 27 , policy makers are yet to be fully aware of the benefits of including exercise specialists in the Ugandan mental health care system. Hence, a need to re-orient the current health care system including policy makers to embrace these professions in the management of mental health problems is needed. Internationally, exercise physiologists 24 and physiotherapists 21 are the health professional groups with expertise in exercise prescription for people with mentalillness. Both health professional groups are trained in exercise prescription for people with chronic and complex health conditions including for those with mental illness. Thus, exercise professionals are able to develop and deliver cost- and resource-efficient exercise interventions. To date, however, few people in Uganda, and Sub-Saharan African as a whole with mental illness are referred to exercise specialists in primary health care settings 27 , 28 . One of reasons might be the lack of mental health training for these exercise professionals in this part of the world 20 .

Despite the fact that the respondents reported a high level of knowledge and confidence in prescribing exercise for people with mental illness, the potential of exercise within the multidisciplinary treatment seems not yet to be fully endorsed in low resource countries. “Standard treatments” for mental illness were generally perceived as of greater therapeutic value to exercise. One reason might be the previously reported strong biomedical focus, while clinicians tend to favor interventions related to their own discipline, for example occupational therapists favor vocational rehabilitation and social skills training while nurses favor family support. Another issue might be the socio-cultural views of mental illness whereby potential patients do not routinely seek treatment due to the high levels of stigma, and where treatment is provided traditionally through non-Westernized approaches. Thus, exercise as part of any treatment strategy is largely underutilized.

In the current study, we also explored barriers to exercise prescription for health care professionals and participation by mental health consumers. A previous study in physical therapists demonstrated that a-motivation by mental health consumers is the most significant barrier to exercise participation 40 , while barriers to exercise prescription by nurses working in mental health in Australia extend to the systemic level 41 . For example, previous research highlighted how the fragmentation of roles, prioritization of other tasks, lack of time, and limited resources impact on the prescription of exercise by nurses working in mental health in Australia 41 . Surprisingly, in our study these barriers were not endorsed by more than half of our respondents. In our study, respondents agreed with a number of statements regarding barriers to exercise participation proposed by people with mental illness. This was especially the case for statements located more at the individual level such as the side effects from pharmacotherapy, and at the community level where stigma and negative attitudes surrounding mental illness were considered a major barrier for people with mental illness to engage in exercise. Therefore, in order to facilitate exercise uptake, deliberate efforts need to be undertaken within the hospital to assist patients in coping with the side effects of their pharmacotherapy while at the community level public health campaigns are needed to reduce the stigma associated with mental illness. These changes should be augmented by professional development opportunities suggested by respondents including the assessment, initiation, and motivation for continued exercise participation by people with mental illness.

Limitations

The present study should be considered in the light of some limitations. First, we were not able to obtain completed surveys from all health care professionals working in mental health setting where the study was undertaken. This could be due to the time commitment required, personal concerns regarding the knowledge related to exercise for people with mental illness and the lack of incentive for participation. Uganda also has a small mental health workforce with around 28 psychiatrists and 230 mental health nurses, most of whom work at Butabika 42 , thus competing priorities may have affected the survey response rate. However, considerable effort was directed towards recruitment and the proportion of professionals who completed surveys represents approximately 90% of the eligible staff. Second, the present survey was also limited to only one hospital. Butabika is however the only national mental health referral center in Uganda. Together with a small cohort, the generalizability of our findings remains to be confirmed while interdisciplinary comparisons were not possible. Third, although the EMIQ-HP has been validated before in Australia 29 , the validity for the mental health workforce in low income countries is unknown.

The present findings suggest nurses and occupational therapists who participated in this study are supportive of exercise, and those who prescribe exercise do so in accordance with accepted protocols. Moreover, respondents disagree with many of the commonly cited barriers to exercise prescription and participation in the current literature. Regarding barriers to exercise participation, reducing stigma at community level should be prioritized. Collaboration with exercise professionals such as exercise physiologists and physiotherapists as part of a multidisciplinary approach to mental health care could increase exercise uptake and consequently improve health outcomes for mental health consumers. Further examination in larger cohorts including all relevant healthcare disciplines will progress our understanding of the delivery of exercise for people with mental illness in low resourced settings.

Acknowledgements

The authors would like to thank the nurses of the Butabika National Referral and Mental Health Hospital who completed the questionnaires for the purpose of this study.

Conflict of interest

None to declare from either author.

This research was funded by Geestkracht VZW.

Role of funding source

The funding organization had no role in the research at any stage, nor influenced the decision to publish the article.

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In CDC survey, 37% of U.S. high school students report regular mental health struggles during COVID-19 pandemic

Many high school students have reported experiencing mental health challenges during the coronavirus outbreak, according to recently published survey findings from the Centers for Disease Control and Prevention (CDC). High school students who are gay, lesbian or bisexual, as well as girls, were especially likely to say their mental health has suffered during the pandemic.

This analysis explores U.S. high school students’ self-reported mental health challenges during the COVID-19 pandemic. It expands on Pew Research Center surveys that have explored U.S. adults’ mental health difficulties during this time. Not all of the survey questions asked specifically about mental health during the pandemic.

This analysis relies on the Center for Disease Control and Prevention’s Adolescent Behaviors and Experiences Survey (ABES), which was conducted from January to June 2021 to assess students’ health-related behaviors and experiences during the COVID-19 pandemic. ABES surveyed high school students in grades 9-12 attending U.S. public and private schools. More information about the survey and its methodology can be found on the CDC’s website.

The results from this one-time survey are not directly comparable to previous CDC surveys on these topics.

Overall, 37% of students at public and private high schools reported that their mental health was not good most or all of the time during the pandemic, according to the CDC’s Adolescent Behaviors and Experiences Survey , which was fielded from January to June 2021. In the survey, “poor mental health” includes stress, anxiety and depression. About three-in-ten high school students (31%) said they experienced poor mental health most or all of the time in the 30 days before the survey. In addition, 44% said that, in the previous 12 months, they felt sad or hopeless almost every day for at least two weeks in a row such that they stopped doing some usual activities. (Not all of the survey questions asked specifically about mental health during the pandemic.)

High school students who are gay, lesbian or bisexual reported higher rates of mental health stresses than their heterosexual (straight) peers. The share of LGB high schoolers who said their mental health was not good most of the time or always during the pandemic was more than double that of heterosexual students (64% vs. 30%). More than half of LGB students (55%) said they experienced poor mental health at least most of the time in the 30 days before the survey, while 26% of heterosexual teens said the same. And about three-quarters of LGB high schoolers (76%) said they felt sad or hopeless almost daily for at least two weeks such that they stopped doing some of their usual activities, compared with 37% of heterosexual students.

There were also differences by gender. About half of high school girls (49%) said their mental health was not good most of the time or always during the COVID-19 outbreak – roughly double the share of boys who said this (24%). And roughly four-in-ten girls (42%) reported feeling this way in the 30 days before the survey; 20% of boys said the same. About six-in-ten high school girls (57%) reported that at some point in the 12 months before taking the survey (in the first half of 2021) they felt sad or hopeless almost every day for at least two weeks in a row such that they stopped doing some usual activities, compared with 31% of high school boys who said this.

LGB high schoolers were also more likely than their heterosexual peers to have sought mental health care – including treatment or counseling for alcohol or drug use – via telemedicine during the COVID-19 pandemic. Around one-in-five LGB students (19%) said they received treatment this way at some point during the pandemic, compared with 6% of heterosexual students. Girls were more likely than boys to have received mental health care through telemedicine (10% vs. 7%, respectively).

Pandemic-related disruptions to schooling, socializing and family life have created a situation that the U.S. surgeon general has described as a “ youth mental health crisis ,” with high rates of teens experiencing distress. But public health experts had called attention to teen mental health even before the coronavirus outbreak. For instance, a separate CDC survey conducted in 2015 found that LGB teens were at greater risk of depression than their heterosexual peers. And a Pew Research Center analysis of pre-pandemic data from the National Survey for Drug Use and Health showed teenage girls were more likely than their male peers to report recent experiences with depression , as well as to receive treatment for it.

• Coronavirus (COVID-19)
• Generation Z
• Happiness & Life Satisfaction
• LGBTQ Attitudes & Experiences
• Teens & Youth

Katherine Schaeffer is a research analyst at Pew Research Center

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