A mental health crisis: the psychological impact of COVID-19 on university students
It doesn’t take a psychologist to tell you that the COVID-19 pandemic has had a huge impact on our mental health. Loneliness, social isolation, fear and uncertainty are all factors known to have a detrimental effect on our wellbeing and have all been exacerbated during the pandemic.
This time has been particularly difficult for vulnerable groups, such as those with chronic illnesses, existing mental health issues or those living on their own. But one particular group has gone through a lot of stress and upheaval this year — students. According to a UNESCO report, 87% of students worldwide were affected by university closures, and with uncertainty over how much longer lockdown restrictions will last, this number is only set to grow.
As 2020 draws to a close, it’s important to reflect on the impact the pandemic has had on students, and assess what measures need to be put in place to help students still facing social isolation and stress when they return to university in the New Year.
The state of mental health in students
Over 200 papers have already been published on the impact of the pandemic on the mental health of students, and the majority bear grim news. Between 12.49 and 72.2% of students reported anxiety, 7.3–45.8% depression and 28% report stress during the pandemic (for example, [1–7]). A number of studies have also shown that the proportion of students struggling with mental health issues has risen compared to before the pandemic, with levels at their worst at the start of lockdowns [8–10]. Nightline also saw the number of calls they receive regarding loneliness triple at the start of the pandemic [11]. Specifically, a survey by YoungMinds found that in the UK 83% of youth responders reported worsening of previous mental health conditions, attributed to school or university closures, loss of routines and social connections [12]. Even population-based studies not directly investigating student mental health found that being a student increased the risk of experiencing mental health issues during the pandemic (for example [13–16].
Worryingly, a survey in Greece estimated there was a 63% increase in the number of students experiencing suicidal thoughts [17], and an increase in self-harm was reported in China [18]. And even for students not experiencing severe mental illness, 57% said their quality of life had worsened due to the pandemic [17]. Furthermore, for many students, the pandemic has been a traumatic experience, either being isolated and far from home, or with students ripped away from their friends at university. A number of studies have focused on this, with one reporting that 2.7% of the students asked reported PTSD-like symptoms [19].
The pandemic has also had a detrimental effect on sleep. Several studies report a worsening in sleep quality during the pandemic [20, 21] and an increase in insomnia symptoms [1, 20, 22] particularly in students with high anxiety. Poor sleep quality has been shown to contribute to the worsening mental health of students during the pandemic, including in the development of PTSD-like symptoms [19].
“There’s no way you can relax there. You’re in a completely different city and you do feel lonely there and trapped.” First-year English student Ewan at Manchester University, BBC news coverage [23].
First-year English student Ewan at Manchester University, BBC news coverage [23].
A huge number of factors have been identified as contributing to this mental health crisis, in particular concerns over the delays to academic progress or graduation [24], financial struggles due to having to leave part-time jobs [25], worries about catching the virus or spreading it to family members [25], inadequate supplies of medicine, food or PPE [26–28] greater time spent reading about COVID-19 online [29] and living in poor-quality housing [30]. Thus, there is currently a huge mental health burden on students that urgently needs addressing.
A disproportionate burden
The COVID-19 crisis hasn’t affected all students equally. A number of studies have reported gender differences, with females and non-binary people being more likely to experience worsened mental health during the pandemic (for example, [24, 26, 30–32]). Younger students also have an increased mental health burden — one study reported the rates of depression dropped by 3% every year older a student was [33] — although a study of UK PhD students also found high rates of stress and worries over academic progress, with approximately 80% of students reporting some degree of mental distress [34].
Other factors that have contributed to an increased risk of mental illness during the pandemic have included living away from parents [35], being unmarried or single [36, 37], being part of the LGBTQ community [37–39] having a history of mental illness [5], being disabled [32] having a lower social capital [40] or lower resilience [41], having no recreational activities [7] or access to outside space [32].
Medical students have also been particularly well studied, with a number of reports finding students were more likely to experience mental health problems than other medical staff [24, 42]. In one study of medical students in China, an enormous 35.5% of the study cohort had depression, with 22.1% having mild anxiety [2]. These effects are greater in medical students compared to other subjects [43], as highlighted by two letters to the British Medical Journal by medical students in the UK [44, 45]. Alternatively, another study found that anxiety was highest in biomedical research students, with many citing the lack of access to laboratories as a key factor underlying their stress [37]. Interestingly psychology students had the lowest risk of depression in Poland [46], potentially due to their greater understanding of mental health and resilience.
The estimated 5.3 million students currently studying abroad have also had a difficult time during the pandemic, in particular the 43.8% that live in the countries hit, including the UK and the USA [47]. Due to travel restrictions, many international students were trapped in their university accommodation for many months, meaning they were far from friends and family, or they had returned home but couldn’t come back to university later in the year [48]. Worryingly, a study of Chinese students studying in Australia also found that discrimination against them had increased, due to derogatory headlines and perpetuation of stereotypes by the media portraying Chinese people as ‘carriers’ of the virus [49].
Tackling the problem
Everyone has their coping strategies, and a number of studies have also reported how students have changed their behaviour during the pandemic, and how this has impacted their mental health. For example, studies from China and the UK found that students that exercised regularly had better overall moods than those who didn’t [50, 51], and a study in India found that 50.8% of students had increased the time they spent gaming as a way of coping with the stress of the pandemic [52]. A study of students in Nigeria also found that fear about COVID-19 increased the consumption of so-called ‘health foods’ [53], although the benefit of these in preventing infection hasn’t been assessed. Nonetheless, these studies validate that known methods of self-care, such as exercise or relaxing doing something you enjoy, can help to counteract the negative impact of the pandemic on mental health.
However, not all coping strategies have been quite so healthy. A study from a university in Ohio, USA, found that the rates of alcohol consumption had increased in students, and this rose overtime during the pandemic. This report also found that having higher anxiety was associated with increased alcohol consumption, whereas greater social support reduced consumption [54]. Similar results were found in Russia and Israel, where 10–14% of students reported binge drinking, with 23.3% of students using cannabis to cope with stress [6, 24]. A study from Greece found that 20–68% of student responders accepted conspiracy theories about the pandemic, which played a role in coping with stress [55], and increased use of social media resulted in worse mental health outcomes [56]. Therefore, students need more mental health support, as well as guidance towards more healthy coping strategies and away from destructive behaviours.
Therefore, many have therefore called for universities to better support students, such as measures to improve resilience [57], increasing the scope of counselling services or simply improving social support to reduce the burden to students [58]. Better information about the pandemic and how to stay healthy may also reduce anxiety in students so universities also need better communication with students.
One intervention trialled to improve the mental health of students was an 8-week long mindfulness course at a Canadian university. In this randomised control trial, students received an 8-week long online course, consisting of videos, mindfulness practice and a peer forum, finding that this reduced depression symptoms and increased mindfulness scores compared to students who didn’t undertake the course [59, 60]. Others have suggested that apps designed to support war veterans could be adapted for university students to improve resilience and reduce the rates of PTSD [61], or the use of ‘self-triage’ sites to provide self-care recommendations [62]. Studies like these demonstrate how even low-cost and simple interventions can make a huge benefit to individuals and help them cope with the stresses of the pandemic and should therefore be implemented in more universities. More also needs to be done to reduce the stigma of COVID-19 to stop the racial prejudices many have faced during the pandemic.
In general, there is a need for more pandemic preparedness, and this must include more training and support to promote resilience, particularly focused on students with an increased risk of mental health issues. Moreover, in a study of US college students, 60% said the pandemic had made it more difficult to access mental health services [63] so systems need to be put in place to support the mental health of students if something like this was ever to happen again.
Unanswered questions…
But despite all this evidence, there are still a lot of unanswered questions about the impact the pandemic has had on students. For example, there have yet to be any studies directly investigating the mental health of students locked down in university accommodation earlier in the year, despite the wealth of news reports suggesting many students were at breaking point, feeling “lonely” and “trapped” in cramped halls. In one devastating case, a 19-year-old student committed suicide while confined to university halls [64]. It’s also likely there will be long-term consequences for students that will far outlive the pandemic. Only time will tell how severe the lasting damage to the mental health of students will be.
There are also overarching issues with the research to date. For example, the majority of published studies focus on students in China [65], simply because the virus has been prevalent there for longer. Moreover, a survey in the UK found that over 98% of respondents identified as Caucasian, so there is limited data on the mental health impact of COVID-19 on minority ethnic students [51]. Going forward, therefore, more research is needed in other countries and more diverse populations within them to ensure these findings generalise to all students. Furthermore, the use of more standardised testing methods and larger sample sizes are needed to better assess the impact of interventions on mental health outcomes.
There is a mental health crisis unfurling in students. Universities need to act now to prevent more students from experiencing detrimental effects on their wellbeing and provide more support for students hit hardest by the pandemic. Without rapid intervention, the psychological impact of the pandemic will only worsen, and the consequences of such may last for years to come.
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