Students’ Negative Emotional Symptoms during COVID-19: Comparison
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The impact of the coronavirus pandemic on negative emotional symptoms has been serious with studies reporting high prevalence rates for these. Isolation, reduced social contact, duration of quarantine and restrictions, which are the characteristics of a lockdown, played an important role in increased negative emotional symptoms for students.

  • isolation
  • emotion
  • university
  • coronavirus
  • depression
  • anxiety

1. Introduction

On 31 December 2019, Wuhan, China, reported the outbreak of the coronavirus disease 19 (COVID-19). One month later (30 January 2020), the World Health Organization (WHO) declared a Public Health emergency of international concern, followed by the confirmation of a global pandemic on 11 March 2020 [1]. This situation brought uncertainty to people and had a dramatic impact on the population. To slow down the propagation of COVID-19, countries were forced into lockdowns by isolating people in their homes, forcing companies, schools and universities to adopt a home-office and home-schooling strategy, the effect of which led to increases in negative emotional symptoms [2], with young adults between 18 and 24 years of age being one of the most affected groups [3].
Negative emotional symptoms are experienced as a response to difficult life circumstances, with the most commonly reported as anxiety, depression and stress [4]. An inability to manage these symptoms effectively can increase the potential for experiencing mental health issues [5]. The two continua model of mental illness and health [6] allows for mental health and mental illness to be separate, but related, constructs. In this way, an individual may experience high levels of anxiety, depression or stress without experiencing mental illness. Long periods without social interaction, as caused by quarantine, is known to increase stress levels and lead to poorer mental health [7]. During quarantine, stress increases as a result of frustration and boredom, inadequate supplies and inadequate information [8]. The impact of this is experiencing higher levels of anxiety and stress [8].
In normal circumstances, university students are exposed to numerous stressors, such as grade requirements, exams or volume of learning material [9]. Beiter [9] further recognized increased stress for students to be caused by the transition of leaving home and living alone (or with other unfamiliar people), making them more susceptible to experiencing negative emotional symptoms than the general population [10]. This exposes university students to a greater risk of developing mental health issues, which is augmented by the COVID-19 pandemic. At this time, many universities moved to online teaching formats, while canceling practical activities, which meant considerable changes to the studying environment for students [11]. The mass changes and uncertainty, coupled with a lack of opportunity to participate in social activities and engage in structured physical activity, left students highly susceptible to developing negative emotional symptoms [12].
The number of studies on the impact of COVID-19 is increasing with a major focus on general population and healthcare workers, who find themselves in the frontline of this battle against the coronavirus. The prevalence of negative emotional symptoms has seen a significant increase in 2021 with reports seven times higher than pre-pandemic levels [13].

2. Current Studies

This meta-analysis regrouped 13 studies with a total of 18,220 participants from nine European countries. The overall pooled prevalence for anxiety, depression and stress was 55% (95% CI: 45–64%), 63% (95% CI: 52–73%) and 62% (95% CI: 43–79%), respectively. Subgroup analysis showed a lower pooled prevalence for studies using the GAD-7 questionnaire (57% (95% CI: 44–69%) vs. 51% (95% CI: 29–73%)), but a higher pooled prevalence for those who used the PHQ-9 questionnaire 69% (95% CI: 56–82%) vs. 48% (95% CI: 25–71%).

32. Discussion

A decrease in mental wellbeing and an increased risk of developing mental disorders have been linked to pandemics in general [14]. Recent literature exposed high prevalence rates of some psychological aspects such as anxiety, depression, stress and distress in several countries around the world in the general population [9][10].
The COVID-19 pandemic brought devastating consequences, not only economically but also psychologically, especially in the younger population. Pre-pandemic, Kessler et al. [15] reported that 6.6% (95% CI: 5.9–7.3%) of the general population of the USA suffered from a major depressive disorder in 2001. Johansson et al. [16] reported a pooled prevalence of 10.8% (95% CI: 9.1–12.5%) for depression, 14.7% (95% CI: 12.7–16.6%) for anxiety and 8.3% (95% CI: 6.8–9.9%) for both in the Swedish population. The European Study of the Epidemiology of Mental Disorders project (ESEMeD) [17] reported that 1 person in 10 of the general population of six European countries (Belgium, France, Germany, Italy, Netherlands, Spain) experienced a mental disorder during the 12 months prior. The pooled prevalence for any anxiety, mental or mood disorder was 6.4% (95% CI: 6.0–6.8%), 9.6% (95% CI: 9.1–10.1%) and 4.2% (95% CI: 3.8–4.6%), respectively, while the prevalence for major depression was 3.9% (95% CI: 3.6–4.2%). In comparison to 2004, the prevalence rates increased drastically in 2021 during the lockdown period of the COVID-19 global pandemic.
Concerning anxiety symptoms, 9 of the 13 studies identified in this meta-analysis, reported an overall prevalence of 49.1%. Meaning, almost half of the participants experienced anxiety symptoms during lockdown. According to the meta-analysis of Wu et al. [18], the overall pooled prevalence of anxiety in students was 28.2% (95% CI: 16.8–41.2%), while Ma et al. [19] found 11% of Chinese students experienced anxiety symptoms. Furthermore, 45.4% of the 898 U.S. young adults reported high anxiety scores (GAD-7 scores ≥ 10) [20]. The result of this last study is close to the pooled prevalence of the current meta-analysis, but the Chinese students reported similar depression symptoms, but much lower prevalence rate for anxiety. For students in China, qualitative studies report this increase in anxiety is caused by a lack of social interaction, intensified by online studying and uncertainty of examination schedules [21], with similar findings in the USA [22] and the UK [23].
In this meta-analysis, 10 out of 13 studies reported an impact in depression, with the overall prevalence reaching 59.7%. Such high prevalence rates can also be observed in student population from other continents. A Chinese study with 746,217 students reported that 45% had probable clinical acute stress, anxiety or depression symptoms. The prevalence rate only for depression was 21.1% [19]. Wu et al. [18] reported in their systematic review and meta-analysis, regrouping 66 studies, that the overall pooled prevalence of depression in students was 34.8% (95% CI: 16.4–55.9%). A study on 898 U.S. young adults also reported high levels of depression (43.3%, PHQ-8 scores ≥ 10). The authors found a significant link between loneliness, COVID-19 specific worries, a low distress tolerance and high levels of depression [20]. Being isolated during a pandemic increases the probability of suffering from depressive symptoms [24]. This study supports the findings above and partly explains the increase of the prevalence of depression. Similarly, students in China have been recognized as having higher depressive levels during COVID-19 [25]. Increases in loneliness have also been reported in UK university students [23], with the authors acknowledging that many students are confined to small rooms with little or no outdoor space, leading to feelings of entrapment. With these results, it can be suggested that Europe has the highest prevalence rate of depression. This may be due to the severity of lockdown rules, the duration of the isolation period, support of the governments or other population/country related aspects.
Lastly, 4 of the 13 identified studies for this meta-analysis focused on the implication of stress with the overall prevalence reaching 47%. Not much less than the European students, Ma et al. [19] reported that acute stress was the most common problem in Chinese students with a prevalence rate of 34.9%. However, a study on 2059 students from an American university reported that 88% experienced moderate to severe stress, which is almost double that of European students and more than double when comparing with Chinese students [26]. Qualitative studies support this finding with increased stress caused by lockdowns during the pandemic described by the university [22]. This is suggested to have greatest impact on first-year students, who were already trying to adapt to commencing university life [23].
Moreover, in order to explain the high prevalence rates, the literature suggests that quarantines, reduced contact, reduced intimacy and social isolation are related to physical and mental health degradation [8][27]. These restrictions were present for weeks and sometimes months during the lockdown period, with long periods of isolation leading to a loss in connectedness and decreases in university students [23]. The results of this analysis demonstrate that the number of students developing negative emotional symptoms is increasing, possibly at the expense of mental wellbeing. This will have long-term implications, even after the pandemic, such as low quality of life, anxiety or depression disorders, post-traumatic stress disorder, low general health and cardiovascular diseases [28]. An increasing demand for psychological help from professionals, due to this increase in negative emotional symptoms, can be expected. Son et al. [22] called for urgent development of intervention and prevention strategies to support the mental health of university students.
Numerous variables can have a different impact on the situation. For example, students living with their families, having their support and the interaction with them, will most likely have a lower incidence of developing negative emotional symptoms compared to students living alone and away from their beloved ones. Similarly, to ensure for social distancing and minimizing contact, universities decided to switch to online classes. Aside from students feeling disadvantaged by remote learning [23], this decreases the opportunity to socialize with others, increasing the prevalence of anxiety and depression to a higher level compared to the general population under normal conditions [29][30][31][32][33][34][35][36][37][38][39][40].

Limitations

The results of this study have to be interpreted carefully because some studies have very high prevalence rates, which influences the overall pooled prevalence. Likewise, some of the studies have a small sample size that often isn’t representative for the whole student population of that country. In order to regroup as much data as possible from different countries, no difference was made between the levels of condition but between experiencing (yes) or not experiencing (no) symptoms. Since the ‘yes’ data section regrouped the conditions from mild to severe or extremely severe, this partly explains the high prevalence rates. A high level of heterogeneity between studies and major asymmetry was found for all three symptoms which suggests a risk of publication bias. The low number of studies does not include the entire or most of the European continent. Furthermore, some studies of different countries had to be dropped because of their incompatible data, which limited the findings and representation of the situation.

References

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