Changes in College Students Mental Health and Lifestyle During the COVID-19 Pandemic: A Systematic Review of Longitudinal Studies

Undergraduate class standing, perceived social support, and depressive symptoms

OBJECTIVE

Investigate the association between perceived social support and depressive symptoms at different stages of academic progress.

PARTICIPANTS

Undergraduate students (n = 505) enrolled at a large southeastern university.

METHODS

Students completed a cross-sectional survey about their self-reported physical and mental health. Logistic regression was used to assess the relationship between depressive symptoms, perceived social support, and academic class standing.

RESULTS

Academic class standing and perceived social support were both significantly associated with depressive symptoms. Compared to freshman, odds of having depressive symptoms were 2.15 times higher for sophomores and 3.94 times higher for seniors. For every one unit increase in perceived social support, the odds of depressive symptoms decreased by 51%.

CONCLUSIONS

A significant association between depressive symptoms and social support was identified for all undergraduates in this sample. The differences identified between social support and depressive symptoms reveal the need to tailor support provided at different academic stages.

Differences in mental health problems in LGBT+ first year college students in Chile during the pandemic

PURPOSE

To examine the differences in mental health problems by sexual orientation and gender identity in first-year university students in Chile during the pandemic.

METHODS

7,213 first-year students aged 18 years and older from five universities participated as part of the World Mental Health - International College Student initiative in Chile. Students completed an online self-report survey between 2020 and 2021 that included measures of lifetime and 12-month major depressive episode, generalized anxiety disorder, panic disorder, bipolar disorder, drug abuse/dependence, alcohol dependence, non-suicidal self-injuries, and suicidal risk. Prevalence of mental health problems were estimated and the differences by sexual orientation and gender identity were examined using logistic and multinomial logistic regression models.

RESULTS

Between 84.1% and 98% of lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) students screened positive for at least one lifetime mental health problem and between 67.6% and 90.6% for two or more problems. For most outcomes, non-heterosexual (Odds Ratio [OR] between 1.25 and 7.00) and trans and gender nonconforming students (OR between 1.72 and 5.81) had significantly higher odds of positive screening for lifetime mental health problems than heterosexual and cisgender students, respectively. Similar results were observed for 12-month mental health problems.

CONCLUSION

The results show differences in the prevalence of mental health problems in LGBT+ university students in Chile, which are consistent with those found in other countries. These results may be useful for planning interventions to improve the mental health of LGBT+ students.

South African emerging adults' capacity for resilience in the face of COVID-19 stressors

Little is known about resilience responses to COVID-19 stressors from emerging adults in minority world contexts. In this cross-sectional study, we explored the association between self-reported COVID-19 stressors and capacity for resilience in 351 emerging adults (Meanage = 24.45, SD = 2.57; 68% female) who self-identified as Black African. We were interested in whether age, gender and neighbourhood quality influenced this association. The main findings were that higher pandemic stress was associated with a greater capacity for resilience. Older participants showed higher levels of resilience, while there was no gender difference in this regard. Those who perceived their neighbourhoods as being of a good quality also showed greater capacity for resilience, despite all participants residing in disadvantaged communities. The theoretical and practical implications of these results are considered.

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey

BACKGROUND

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

OBJECTIVE

This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

METHODS

A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

RESULTS

Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

CONCLUSIONS

These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health.

TRIAL REGISTRATION

RR2-10.2196/41040.

Examining enduring effects of COVID-19 on college students' internalizing and externalizing problems: A four-year longitudinal analysis

BACKGROUND

College students' mental health has been a vital concern for researchers, policymakers, administrators, and educators since before the pandemic, and it is crucial to identify the extent to which the pandemic affected college students' mental health.

METHODS

The current study utilized data repeatedly collected over more than four years (2017-2022) from N = 355 students enrolled at a large public research university in the Midwestern US. The data collection period coincided with the COVID-19 pandemic's onset, facilitating systematic examination of whether and how college students' trajectories (i.e., level and slopes) of depressive symptoms, social anxiety, general disinhibition, callous aggression, and problematic alcohol use changed as the pandemic progressed. Across seven waves, surveys assessed multiple outcome and predictor domains. Multilevel growth curve modeling was used to analyze all outcomes.

RESULTS

Depression symptoms peaked mid-pandemic, whereas social anxiety first declined then continued rising. General disinhibition and callous aggression showed non-significant changes in trajectories. Problematic alcohol use decreased continuously with no significant pandemic-associated effects in the best-fitting model.

LIMITATIONS

An important limitation is reliance on a sample from a single campus utilizing self-reported, non-clinical assessments. Another important limitation is the lack of location information from participants during the acute COVID-19 phase.

CONCLUSIONS

Reported longitudinal analyses expand upon findings from previous limited repeated-measures and cross-sectional studies. In terms of clinical significance, some of the most harmful COVID-19 effects to mental health may be long-lasting and cumulative, making them difficult to detect in shorter-term or cross-sectional studies. Altogether, findings demonstrate complex changes in students' mental health that may have ongoing effects on well-being during key developmental stages.

Meaning in life during the COVID-19 pandemic in Brazil: Impact of quality of life and sociodemographic factors

Research on meaning in life typically emphasizes the psychological aspects of quality of life, neglecting broader dimensions. Additionally, its relevance to the COVID-19 context remains limited. This study investigated the relationship of meaning in life with quality of life and sociodemographic factors related to COVID-19 pandemic in Brazil. A total of 4133 Brazilian adults completed Meaning in Life Questionnaire (MLQ), WHOQOL-BREF, WHOQOL-SRPB BREF, and sociodemographic information. Our results indicated a positive correlation between the presence of meaning and quality of life dimensions, with psychological health exhibiting the strongest relationship. We found a lower presence of meaning among individuals experiencing heightened social isolation, while vaccinated individuals exhibited a greater presence of meaning. Additionally, non-working participants reported lower presence and higher search for meaning than employed individuals, with frontline workers showing the highest search for meaning. Theoretical and practical implications of these findings are discussed.

The association between intergenerational relationships and depression among older adults: A comprehensive systematic literature review

OBJECTIVE

This systematic review aims to comprehensively examine the relationship between intergenerational relationships and depression among older adults in Eastern Asian countries.

METHODS

For this research, a systematic search was conducted on several electronic databases including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar search engine up until June 2023.

RESULTS

Out of 953 articles initially identified, 33 met the inclusion criteria. Emotional support and financial support emerged as crucial factors that can significantly reduce depressive symptoms among older individuals. However, there are diverse and sometimes contradictory results regarding the impact of intergenerational instrumental support on depression in older adults.

CONCLUSION

Promoting positive intergenerational relationships and enhancing support systems can greatly benefit the mental health of older adults by addressing depression within this population. This review enhances our understanding of the complex relationship between intergenerational relationships and depression among older adults. The diverse findings on intergenerational instrumental support and depression in older adults suggest the need for further research to clarify this relationship and its nuances. This research may have practical implications for policies and interventions aimed at improving the mental well-being of older adults in Eastern Asian countries.

Sexual behavior of university students in the context of the COVID-19 pandemic: a mixed-methods study

OBJECTIVE

To analyze the sexual behaviors of university students during the COVID-19 pandemic.

METHOD

Mixed study, carried out on four campuses of a public university in Paraíba, Brazil, between March 2021 and April 2022. The research followed ethical precepts.

RESULTS

404 university students were included, with an average age of 23.7 years, predominantly female, brown and single. The prevalence of self-reported sexually transmitted infections was 7.9%. Male students were more likely to engage in risky sexual behavior. Multiple logistic regression indicated that university students aged 25 or over who had engaged in casual sex in the last 12 months and had received or paid for sex were more likely to have sexually transmitted infections. The content analysis showed that social isolation was reflected in reduced consumption of alcohol and other substances, reduced sexual practices, increased use of social networks, as well as low adherence to condoms.

CONCLUSION

Physical distancing has an impact on the sexual behavior of university students, as well as on the consumption of alcohol and other substances.

Multivariate patterns of brain functional connectome associated with COVID-19-related negative affect symptoms

Severe mental health problems with the representation of negative affect symptoms (NAS) have been increasingly reported during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to explore the multivariate patterns of brain functional connectome predicting COVID-19-related NAS. This cohort study encompassed a group of university students to undergo neuroimaging scans before the pandemic, and we re-contacted participants for 1-year follow-up COVID-related NAS evaluations during the pandemic. Regularized canonical correlation analysis was used to identify connectome-based dimensions of NAS to compute pairs of canonical variates. The predictive ability of identified functional connectome to NAS dimensional scores was examined with a nested cross-validation. Two dimensions (i.e. mode stress and mode anxiety) were related to distinct patterns of brain functional connectome (r2 = 0.911, PFDR = 0.048; r2 = 0.901, PFDR = 0.037, respectively). Mode anxiety was characterized by high loadings in connectivity between affective network (AFN) and visual network (VN), while connectivity of the default mode network with dorsal attention network (DAN) were remarkably prominent in mode stress. Connectivity patterns within the DAN and between DAN and VN, ventral attention network, and AFN was common for both dimensions. The identified functional connectome can reliably predict mode stress (r = 0.37, MAE = 5.1, p < 0.001) and mode anxiety (r = 0.28, MAE = 5.4, p = 0.005) in the cross-validation. Our findings provide new insight into multivariate dimensions of COVID-related NAS, which may have implications for developing network-based biomarkers in psychological interventions for vulnerable individuals in the pandemic.

Examining the Trajectory of Health-Related Quality of Life among Coronavirus Disease Patients

BACKGROUND

Recent studies have reported a reduction in health-related quality of life (HR-QoL) among post-coronavirus disease 2019 (COVID-19) patients. However, there remains a gap in research examining the heterogeneity and determinants of HR-QoL trajectory in these patients.

OBJECTIVE

To describe and identify factors explaining the variability in HR-QoL trajectories among a cohort of patients with history of COVID-19.

DESIGN

A prospective study using data from a cohort of COVID-19 patients enrolled into a registry established at a health system in New York City.

PARTICIPANTS

Participants were enrolled from July 2020 to June 2022, and completed a baseline evaluation and two follow-up visits at 6 and 12 months.

METHODS

We assessed HR-QoL with the 29-item Patient Reported Outcomes Measurement Information System instrument, which was summarized into mental and physical health domains. We performed latent class growth and multinomial logistic regression to examine trajectories of HR-QoL and identify factors associated with specific trajectories.

RESULTS

The study included 588 individuals with a median age of 52 years, 65% female, 54% White, 18% Black, and 18% Hispanic. We identified five physical health trajectories and four mental health trajectories. Female gender, having pre-existing hypertension, cardiovascular disease, asthma, and hospitalization for acute COVID-19 were independently associated with lower physical health. In addition, patients with increasing body mass index were more likely to experience lower physical health over time. Female gender, younger age, pre-existing asthma, arthritis and cardiovascular disease were associated with poor mental health.

CONCLUSIONS

We found significant heterogeneity of HR-QoL after COVID-19, with women and patients with specific comorbidities at increased risk of lower HR-QoL. Implementation of targeted psychological and physical interventions is crucial for enhancing the quality of life of this patient population.

The relationship between volunteering and cognitive performance in older adults: A systematic review

OBJECTIVES

This systematic review aims to examine the relationship between cognition and volunteering in older adults, with a specific focus on domain-specific outcomes.

METHODS

In April 2023, a comprehensive search was conducted across multiple electronic databases including PubMed, Google Scholar, ScienceDirect, Web of Science, and Scopus. The inclusion criteria for the study were limited to longitudinal studies or randomized controlled trials (RCTs). The quality and risk of bias of the included articles were assessed using the Newcastle-Ottawa Scale and Consolidated Standards of Reporting Trials (CONSORT).

RESULTS

Out of 3575 articles retrieved, 17 studies were eligible for inclusion in this review. The majority of these studies were conducted in high-income countries. Of the 17 studies reviewed, 16 found a positive association between volunteering and cognitive benefits.

CONCLUSION

The analysis of seventeen studies meeting the predefined inclusion criteria suggests a potential positive correlation between volunteering and cognitive function among older adults. Some demographic factors such as gender and education level were observed to have an influence on this relationship. It was found that older adults who engage in volunteering may exhibit better episodic memory, working memory, and verbal fluency compared to non-volunteers. However, due to limitations in the existing research and variations across studies, further investigation is needed to establish definitive conclusions.

Social Support, Psychological Strain, and Suicidality: Evidence from Chinese Universities

This study aimed to apply psychological strain theory to explore the relationship between psychological strain and suicidality among Chinese young adults with a moderating effect of perceived social support. A questionnaire was administered with the Multidimensional Scale of Perceived Social Support (MSPSS), Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Psychological Strain Scale (PSS) among 13,250 college students across China. The main determinants of suicidal behavior were examined with multiple linear regression. Two steps of multiple regression were employed to define the moderating effect of social support. A positive relationship between psychological strain and suicidality was reported in the study, and social support was confirmed as a moderating factor between psychological strain and suicidal behavior.

Depression and Anxiety Symptoms and Their Associated Factors Among Chinese Residents After the Lifting of the Dynamic Zero-COVID Policy: A Cross-Sectional Study

Purpose

China lifted its strict zero-Covid approach on December 7, 2022. This study aimed to investigate depression and anxiety symptoms and their associations among Chinese residents after the change in public policy.

Methods

A cross-sectional sample of 925 Chinese residents (726 females and 199 males) was recruited using convenience and snowball sampling approach between 16 and 25 December 2022. Participants completed online questionnaires on basic information, depression, anxiety, COVID-19 related perceptions, and protective behaviors change.

Results

Mild and moderate-to-severe depression symptoms were reported by 35.6% and 19.1% of participants, respectively. Nearly 40% of participants reported mild anxiety and 18.7% reported moderate-to-severe anxiety. Results from multinomial logistic regression analysis indicated that male gender, younger age, the presence of chronic disease, poorer self-rated mental health status, perceived impact, and worry were risk factors for both depression and anxiety, while higher education and protective behaviors change were protective factors. Besides, living with or caring for children (4-6 years), family members or other housemates currently with influenza-like symptoms, and perceived severity were also risk factors for depression.

Conclusion

Our findings provided initial evidence that Chinese residents may face heightened depression and anxiety during the early stage after the policy was released. Furthermore, we identified some vulnerable populations in need of prioritizing mental health assistance and some potentially modifiable factors associated with depression and anxiety, which provides an important guide for developing timely and effective psychological interventions and preparing for future pandemics.

The Impact of COVID-19 Health and Safety Measures on the Self-Reported Exercise Behaviors and Mental Health of College Students

The public-health restrictions (e.g., remote learning, restricted access to facilities and dining halls) put in place by colleges to reduce the spread of COVID-19 resulted in forced isolation and modifications to health-related behaviors. The restrictions and uncertainty associated with COVID-19 may have exacerbated the challenges of meeting exercise recommendations and mental-health concerns. The purpose of this study was to assess the impact of restrictions on students' exercise habits and their levels of anxiety, stress, and depression. Five-hundred and forty students completed a 29-question survey on individual demographics, living arrangements, exercise, sleep, diet, and mental health. Significant changes in weekly days of exercise and intensity were reported. Increases in anxiety, stress, and depression were reported. The two most frequently reported changes in exercise behavior were an increase in minutes of aerobic training (5%) and a combination of reduced minutes of aerobic and resistance training (3.9%), which could be reflective of an individual's ability and/or desire to maintain exercise behavior during the restrictions. Alternatively, for those students who reduced their exercise habits, aerobic training (11%) was the mode that suffered the most. Demographic factors such as ethnicity, regional residence, and gender were found to have significant effects on stress, anxiety, and depression. Amidst pandemics and future health emergencies, colleges should prioritize establishing opportunities for students to exercise, helping them meet physical activity recommendations and combat mental-health issues.

Factors associated with perceived stress and depressive symptoms among college students during the COVID-19 pandemic

The COVID-19 pandemic had detrimental effects on college students' psychosocial well-being due to campus closures starting in Spring 2020. This study examined changes in perceived stress and depressive symptoms before and during the pandemic using longitudinal data collected from students over the 2019-2020 academic year. We also compared data from this sample in Fall 2019 (N = 282) to data collected from another sample in Fall 2020 (N = 240). Latent change modeling showed increases in stress during Spring 2020. Additionally, the Fall 2020 sample had higher levels of stress than the Fall 2019 sample. Differences in stress and depressive symptoms did not depend on underrepresented minority (URM) status, income, gender, or membership in Greek life or other organizations. However, third- and fourth-year students and student-athletes experienced more stress during the pandemic. Findings suggest an adverse and differential impact of the pandemic on students' psychosocial well-being.

Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada

OBJECTIVES

The pandemic and public health response to contain the virus had impacts on many aspects of young people's lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates.

DESIGN

Population-based repeated cross-sectional study.

SETTING

Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada.

PARTICIPANTS

All children 6-12 years of age (n=2 043 977), adolescents 13-17 years (n=1 708 754) and young adults 18-24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021.

PRIMARY OUTCOME MEASURES

Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex.

RESULTS

During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries.

CONCLUSIONS

Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.

A Review Article on Exercise Intolerance in Long COVID: Unmasking the Causes and Optimizing Treatment Strategies

There is a growing body of research on SARS-CoV-2 (PASC), previously known as the post-COVID syndrome, a chronic condition characterized by symptoms that persist after SARS-CoV-2 infection. Among these symptoms, feelings of physical exhaustion and prolonged fatigue are particularly prevalent and can significantly impact patients' quality of life. These symptoms are associated with reduced overall physical capacity, decreased daily physical activity, malaise after intense training, and intolerance to physical activity (IFA). IFA, described as a reduced ability to perform physical activities typical for the patient's age, can often lead to a sedentary lifestyle. Prolonged physical inactivity can cause deterioration in the overall physical condition and disrupt mitochondrial function, triggering a vicious cycle of gradual symptom worsening. The underlying causes of PASC remain unclear; however, several biochemical mechanisms have been discussed to explain the body's energy depletion, and a multidisciplinary approach that combines physical and cognitive rehabilitation and lifestyle interventions such as exercise and diet modifications has been suggested to improve the overall health and well-being of PASC patients. This critical review aims to review the existing research on the possible causes and links among chronic fatigue, reduced physical activity, and exercise intolerance in patients with PASC. Further research into the underlying causes and treatment of PASC and the importance of developing individualized treatment is needed to address each patient's unique health requirements.

Gender differences in alcohol abuse/dependence among medical undergraduates during the post-COVID‑19 pandemic period (October 20, 2020-April 5, 2021) in China

BACKGROUND

This study aimed to assess the prevalence and the gender-specific risk factors of alcohol abuse/dependence among medical undergraduates during the post-COVID‑19 pandemic period in China.

METHOD

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) was used to identify respondents with alcohol abuse/dependence. A questionnaire on basic demographics and mental distresses (learning burnout, depression symptoms, anxiety symptoms, excessive daytime sleepiness, and history of mental disorders) was used. The logistic regression model was used to explore the associations between the above characteristics and alcohol abuse/dependence.

RESULTS

A total of 3,412 medical undergraduates were included in the analysis. Males showed a higher prevalence of alcohol abuse/dependence than females (16.6% vs 7.4%, p < 0.001). Alcohol abuse/dependence was associated with learning burnout (OR: 2.168, p < 0.001) and having a partner (OR: 1.788 p = 0.001) among female medical undergraduates. Among male medical undergraduates, excessive daytime sleepiness (OR: 1.788 p = 0.001) and older age (OR: 1.788, p = 0.001) were independently associated with alcohol abuse/dependence.

CONCLUSION

Alcohol abuse/dependence was common among medical undergraduates during the post-COVID‑19 pandemic period. Substantial gender differences in the prevalence and risk factors of alcohol abuse/dependence were found among medical undergraduates in this study, which highlighted the need for timely gender-specific screening and interventions. However, the cross-sectional design adopted in this study has limited the examination of causality, thus further longitudinal studies are warranted.

The impact of the COVID-19 pandemic on adolescent mental health across the world

The global impact of the COVID-19 pandemic on adolescents has been substantial. The current review aimed to summarize the existing literature on the impact of the pandemic on mental health during adolescence, with a specific focus on longitudinal studies. The findings from these studies indicated that many adolescents experienced increased mental health problems, especially those who were already vulnerable prior to the pandemic. Several preexisting factors, such as socioeconomic background and gender, and pandemic-related factors, such as perceived stress and restrictive measures, were identified that contribute to interindividual differences in how adolescents were affected by the pandemic. However, it is crucial to interpret these changes in the context of the ongoing trend of increasing mental health problems among youth over the past decades.

A mixed-methods investigation of COVID-19 pandemic-specific stress in college students

OBJECTIVE

To identify pandemic-specific stressors among college students and compare patterns of stressors in samples obtained during early and chronic phases of the pandemic.

METHOD

Different undergraduate student samples from a Southeastern university completed an online survey in Spring 2020 (early pandemic; N = 673) and Fall 2020 (chronic pandemic; N = 439). This repeated cross-sectional survey study used a mixed methods triangulation design to validate and expand on quantitative findings using qualitative data.

RESULTS

Quantitative and qualitative analyses revealed 13 pandemic stressor domains, with academics and lifestyle adjustment among the most stressful in both samples, and more stressful in the chronic pandemic sample. Non-freshmen, female, and first-generation college students were at greater risk for pandemic stress.

CONCLUSIONS

As college students continue to experience stressors related to COVID-19 and encounter future crises, colleges and universities must adapt to meet their unique needs specific to the context.

Emerging Adult Resilience to the Early Stages of the COVID-Pandemic: A Systematic Scoping Review

Human resilience to COVID-19 related stressors remains a pressing concern following the aftereffects of the pandemic and in the face of probable future pandemics. In response, we systematically scoped the available literature (n = 2030 records) to determine the nature and extent of research on emerging adults' adaptive responses to COVID-19 stressors in the early stages of the pandemic. Using a multisystem resilience framework, our narrative review of 48 eligible studies unpacks the personal, relational, institutional and/or physical ecological resources that enabled positive emerging adult outcomes to COVID-18 stressors. We found that there is a geographical bias in studies on this topic, with majority world contexts poorly represented. Resources leading to positive outcomes foregrounded psychological and social support, while institutional and ecological supports were seldom mentioned. Multisystemic combinations of resources were rarely considered. This knowledge has valuable implications for understanding resilience in the context of other large-scale adverse conditions.

Investigating Relationships Among Self-Efficacy, Mood, and Anxiety Using Digital Technologies: Randomized Controlled Trial

BACKGROUND

Digital tools assessing momentary parameters and offering interventions in people's daily lives play an increasingly important role in mental health research and treatment. Ecological momentary assessment (EMA) makes it possible to assess transient mental health states and their parameters. Ecological momentary interventions (EMIs) offer mental health interventions that fit well into individuals' daily lives and routines. Self-efficacy is a transdiagnostic construct that is commonly associated with positive mental health outcomes.

OBJECTIVE

The aim of our study assessing mood, specific self-efficacy, and other parameters using EMA was 2-fold. First, we wanted to determine the effects of daily assessed moods and dissatisfaction with social contacts as well as the effects of baseline variables, such as depression, on specific self-efficacy in the training group (TG). Second, we aimed to explore which variables influenced both groups' positive and negative moods during the 7-day study period.

METHODS

In this randomized controlled trial, we applied digital self-efficacy training (EMI) to 93 university students with elevated self-reported stress levels and daily collected different parameters, such as mood, dissatisfaction with social contacts, and specific self-efficacy, using EMA. Participants were randomized to either the TG, where they completed the self-efficacy training combined with EMA, or the control group, where they completed EMA only.

RESULTS

In total, 93 university students participated in the trial. Positive momentary mood was associated with higher specific self-efficacy in the evening of the same day (b=0.15, SE 0.05, P=.005). Higher self-efficacy at baseline was associated with reduced negative mood during study participation (b=-0.61, SE 0.30, P=.04), while we could not determine an effect on positive mood. Baseline depression severity was significantly associated with lower specific self-efficacy over the week of the training (b=-0.92, SE 0.35, P=.004). Associations between higher baseline anxiety with higher mean negative mood (state anxiety: b=0.78, SE 0.38, P=.04; trait anxiety: b=0.73, SE 0.33, P=.03) and lower mean positive mood (b=-0.64, SE 0.28, P=.02) during study participation were found. Emotional flexibility was significantly enhanced in the TG. Additionally, dissatisfaction with social contacts was associated with both a decreased positive mood (b=-0.56, SE 0.15, P<.001) and an increased negative mood (b=0.45, SE 0.12, P<.001).

CONCLUSIONS

This study showed several significant associations between mood and self-efficacy as well as those between mood and anxiety in students with elevated stress levels, for example, suggesting that improving mood in people with low mood could enhance the effects of digital self-efficacy training. In addition, engaging in 1-week self-efficacy training was associated with increased emotional flexibility. Future work is needed to replicate and investigate the training's effects in other groups and settings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05617248; https://clinicaltrials.gov/study/NCT05617248.

Improving stress management, anxiety, and mental well-being in medical students through an online Mindfulness-Based Intervention: a randomized study

Pressures and responsibilities of medical school put a strain on medical student's personal wellbeing, leading among all to high rates of anxiety, emotional discomfort and stress. In this work we evaluated the effectiveness of a comprehensive Mindfulness-Based Intervention (MBI) in reducing this load. The intervention comprised 10 twice-a-week Integral Meditation classes, dietary advice, and brief yoga sessions. We performed a randomized trial on two cohort of medical students from Italian universities: 239 in cohort 1 (106 treated and 133 controls), and 123 in cohort 2 (68 treated and 55 control) for a total sample of 362 students. Nine questionnaires for evaluating the effectiveness of our intervention on stress (PSS), state anxiety (STAIX-1), well-being (WEMWBS), mind-wandering (MW-S), overall distress (PANAS), emotion regulation (DERS), resilience (RS-14), and attentional control (ACS-C and ACS-D) were collected both pre and post intervention. Linear mixed effect models were run on the whole sample showing that, after multiple testing correction, our intervention was effective in reducing perceived stress (β = - 2.57 [- 4.02; - 1.12], p = 0.004), improving mental well-being (β = 2.82 [1.02; 4.63], p = 0.008) and emotional regulation (β = - 8.24 [- 12.98; - 3.51], p = 0.004), resilience (β = 3.79 [1.32; 6.26], p = 0.008), reducing the tendency to wander with the mind (β = - 0.70 [- 0.99; - 0.39], p = 0.0001), ameliorating the ability to maintain attention (AC-S (β = - 0.23 [- 0.44; - 0.02], p = 0.04) and AC-D (β = - 0.19 [- 0.36; - 0.01], p = 0.04)), and the overall distress (β = 1.84 [0.45; 3.23], p = 0.02).

Attending lectures in person, hybrid or online-how do students choose, and what about the outcome?

As a consequence of the COVID-19 pandemic, most courses at a large technical university were adapted so that students had a free choice of whether to attend lectures on-site or online; in addition, in many courses, lecture recordings were available. At the subsequent exam session, over 17,000 student-survey responses were collected regarding attendance choices, learning behavior, interest in the course, perception of the exam, and recommendations to future students. A total of 27 learner attributes and their relationships were investigated. In addition, conditional attributes and free-response statements were analyzed, and the students' exam grades were retrieved to gauge their performance. We found only minute differences with respect to exam performance, but the analysis indicates distinctly different preferences and constraints in taking advantage of learning opportunities. We also found some indications that performance differences might be larger for interactive-engagement courses. The results of the analysis may be key to answering why at many universities, faculty report that live-lecture attendance has decreased more strongly than expected with the availability of new, virtual attendance modes.

Experience of Ethnic Discrimination, Anxiety, Perceived Risk of COVID-19, and Social Support among Polish and International Students during the Pandemic

BACKGROUND

Our research aimed to assess the experiences of ethnic discrimination among students in Poland (Polish and international) during the COVID-19 pandemic. We also tested the prevalence of anxiety symptoms and their relationship with perceived COVID-19 risk, the severity of discrimination, and social support.

METHODS

The data from Polish (n = 481) and international university students (n = 105) were collected online (November-January 2020). Participants completed measures of ethnic discrimination (GEDS), anxiety scale (GAD-7), COVID-19 risk perception index, and perceived social support scale (MSPSS) questionnaires.

RESULTS

The results showed that international students reported being much more discriminated than Polish students during the first year of the COVID-19 pandemic. Contrary to our expectation, a higher risk of anxiety disorders (GAD) was observed in 42% of Polish students compared to 31% of international students. The predictors of higher anxiety symptoms among both groups were the perceived risk of COVID-19 and the greater severity of ethnic discrimination. In both groups, the perceived social support had a protective role in anxiety symptomatology.

CONCLUSIONS

The high prevalence of discrimination, especially among international students, simultaneously with high symptoms of anxiety, requires vigorous action involving preventive measures and psychological support.

Mental Health and COVID-19 in University Students: Findings from a Qualitative, Comparative Study in Italy and the UK

INTRODUCTION

COVID-19 restrictions introduced several changes in university academic and social experience. Self-isolation and online teaching have amplified students' mental health vulnerability. Thus, we aimed to explore feelings and perspectives about the impact of the pandemic on mental health, comparing students from Italy and the UK.

METHODS

Data were collected from the qualitative portion of "the CAMPUS study", longitudinally assessing mental health of students at the University of Milano-Bicocca (Italy) and the University of Surrey (UK). We conducted in-depth interviews and thematically analysed the transcripts.

RESULTS

The explanatory model was developed from four themes identified across 33 interviews: anxiety exacerbated by COVID-19; putative mechanisms leading to poor mental health; the most vulnerable subgroups; and coping strategies. Generalised and social anxiety resulted from COVID-19 restrictions by being associated with loneliness, excessive time online, unhealthy management of time and space and poor communication with the university. Freshers, international students, and people on the extremes of the introversion/extroversion spectrum, were identified as vulnerable, while effective coping strategies included taking advantage of free time, connection with family and mental health support. The impact of COVID-19 was mostly related to academic issues by students from Italy, whereas to the drastic loss of social connectedness by the UK sample.

CONCLUSIONS

Mental health support for students has an essential role, and measures that encourage communication and social connectedness are likely to be beneficial.

The Psychological Impact of the COVID-19 Pandemic on Alcohol Abuse and Drunkorexia Behaviors in Young Adults

The COVID-19 outbreak negatively affected young adults' psychological well-being, increasing their stress levels and symptoms of anxiety and depression, and potentially triggering health-risk behaviors. The present study was aimed at investigating the psychological impact of the COVID-19 pandemic on alcohol abuse and drunkorexia behaviors among young adults living in Italy. Participants were 370 emerging adults (63% women, 37% men; Mage = 21.00, SDage = 2.96, range: 18-30) who were recruited through an online survey between November 2021 and March 2022. Participants completed measures of alcohol abuse, drunkorexia behaviors, negative life experiences, and post-traumatic symptoms related to the COVID-19 outbreak. The results showed that the emotional impact and negative life experiences associated with the pandemic predicted both alcohol abuse and drunkorexia behaviors, albeit in different ways. Specifically, the number of negative life experiences during the pandemic and the tendency to avoid COVID-19-related negative thoughts positively predicted alcohol abuse; and the presence of intrusive thoughts associated with the pandemic significantly predicted the frequency of drunkorexia behaviors. Implications for research and clinical practice are discussed.

Effect of Mobile Phone Addiction on Physical Exercise in University Students: Moderating Effect of Peer Relationships

OBJECTIVE

The influence of mobile phone addiction (MPA) on physical exercise in university students was explored, and peer relationships were introduced as a moderating variable.

METHODS

A cross-sectional study design was adopted, and an online survey questionnaire was conducted to investigate two universities in Nantong City, Jiangsu Province, and Chongzuo City, Guangxi Zhuang Autonomous Region. A total of 4959 university students completed the questionnaire. Measurement tools included the Mobile Phone Addiction Tendency Scale, the Physical Activity Rating Scale, and the Peer Rating Scale of university students.

RESULTS

University students scored 39.322 ± 15.139 for MPA and 44.022 ± 7.735 for peer relationships, with 87.8% of their physical exercise, in terms of exercise grade, being classified as medium or low intensity. The MPA of the university students was negatively correlated with peer relationships (r = -0.377, p < 0.001) and physical exercise behavior (r = -0.279, p < 0.001). The moderating effect of peer relationships on the MPA-physical exercise behavior relationship was significant (ΔR² = 0.03, p < 0.001).

CONCLUSIONS

The physical exercise of university students was at a medium or low intensity. The more serious the university students' addiction to mobile phones was, the lower the amount of physical exercise. The physical activity of males was higher than that of females. MPA and peer relationships were the limiting factors of the physical exercise behavior of university students. Under the lower effect of peer relationship regulation, MPA had a greater negative impact on physical exercise behavior. The data from this research can provide theoretical support to improve the participation of university students in physical activities.

Associations Between Problematic Internet Use and Mental Health Outcomes of Students: A Meta-analytic Review

The increasing prevalence of problematic internet use has heightened concerns about its adverse impact on internet users' mental health. Despite reviews investigating the associations between problematic internet use and mental health outcomes, there is a lack of understanding of various aspects of students' mental health. This study aimed to bridge this gap by providing a more comprehensive overall picture of this issue through a quantitative synthesis based on three-level random-effects meta-analytic models. In total, 223 studies with a cumulative total of 498,167 participants and 512 effect sizes were included in this synthesis. The results showed that problematic internet use was moderately and positively associated with depressive symptoms, anxiety, loneliness, and other mental health outcomes, and negatively related to subjective well-being. Moderator analyses revealed that several study features (i.e., school grade, region, measure of problematic internet use, publication year, and gender) could explain the variations in the findings across individual studies. These research results provide solid evidence for the link between problematic internet use and different mental health outcomes and have implications for future research and interventions on students' problematic internet use.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-022-00201-9.

Current Status and Correlation of Physical Activity and Tendency to Problematic Mobile Phone Use in College Students

OBJECTIVE

To explore the effect of problematic mobile phone use on college students' physical activity and their relationships.

METHODS

A cross-sectional study was conducted among 3980 college students from three universities in Jiangsu province by random cluster sampling. The International Physical Activity Questionnaire Short (IPAQ-SF) measured college students' physical activity. The Mobile Phone Addiction Tendency Scale for College Students (MPATS) measured problematic mobile phone use tendencies. College students' physical activity was measured by the International Physical Activity Questionnaire Short (IPAQ-SF), and the Mobile Phone Addiction Tendency Scale measured their mobile phone addiction tendency for College Students (MPATS).

RESULTS

(1) The proportions of the low-, medium-, and high-intensity physical activity were 83.5%, 10.7%, and 5.8%, respectively, with gender differences; The score of problematic mobile phone use tendency was 38.725 ± 15.139. (2) There were significant differences in problematic mobile phone use tendency among college students with different physical activity intensity (F = 11.839, p < 0.001, η² = 0.007). (3) The level of physical activity was significantly correlated with the tendency of problematic mobile phone use (r = -0.173, p < 0.001). (4) Physical activity of college students could significantly predict the tendency of problematic mobile phone use (F (3,3605) = 11.296, p < 0.001).

CONCLUSIONS

The physical activity of college students was mainly moderate to low intensity, while the tendency of problematic mobile phone use was high. College students' physical activity level was one of the important constraints of problematic mobile phone use tendency.

Health-Related Quality of Life and Mental Well-Being during the COVID-19 Pandemic in Five Countries: A One-Year Longitudinal Study

This study aimed to investigate socioeconomic and health-related determinants and recent life events and their relation to changes in health-related quality of life (HRQoL) and mental well-being during the first year of the COVID-19 pandemic. A web-based survey was administered repeatedly to participants from Greece, Italy, the Netherlands, the United Kingdom, and the United States. Primary outcome measures were HRQoL (measured by EQ-5D-5L) and mental well-being (measured by WHO-5). Linear regression analyses were performed to estimate the impact of determinants on HRQoL and well-being. In total, 6765 respondents completed the questionnaire at T1 (April-May 2020) and T2 (May-June 2021). Regarding results, 33% showed improved HRQoL at T2, whereas 31% deteriorated. In terms of mental well-being, 44% improved and 41% deteriorated. The greatest deterioration in HRQoL and mental well-being from T1 to T2 was observed with an increasing number of chronic conditions. The effect of negative life events on HRQoL and mental well-being was larger than the effect of positive life events. We conclude that slightly more respondents showed improved rather than deteriorated HRQoL and mental well-being, with some variation by outcome measure and country.