Psychological, Behavioral, and Interpersonal Effects and Clinical Implications for Health Systems of the Coronavirus (COVID-19) Pandemic: A Call for Research

Mucosal immunity in COVID-19: a comprehensive review

Mucosal immunity plays a crucial role in defending against coronaviruses, particularly at respiratory sites, serving as the first line of defense against viral invasion and replication. Coronaviruses have developed various immune evasion strategies at the mucosal immune system, hindering the recognition of infected cells and evading antibody responses. Understanding the immune mechanisms and responses is crucial for developing effective vaccines and therapeutics against coronaviruses. The role of mucosal immunity in COVID-19 is significant, influencing both local and systemic immune responses to the virus. Although most clinical studies focus on antibodies and cellular immunity in peripheral blood, mucosal immune responses in the respiratory tract play a key role in the early restriction of viral replication and the clearance of SARS-CoV-2. Identification of mucosal biomarkers associated with viral clearance will allow monitoring of infection-induced immunity. Mucosally delivered vaccines and those under clinical trials are being compared and contrasted to understand their effectiveness in inducing mucosal immunity against coronaviruses. A greater understanding of lung tissue-based immunity may lead to improved diagnostic and prognostic procedures and novel treatment strategies aimed at reducing the disease burden of community-acquired pneumonia, avoiding the systemic manifestations of infection and excess morbidity and mortality. This comprehensive review article outlines the current evidence about the role of mucosal immune responses in the clearance of SARS-CoV-2 infection, as well as potential mucosal mechanisms of protection against (re-)infection. It also proposes that there is a significant role for mucosal immunity and for secretory as well as circulating IgA antibodies in COVID-19, and that it is important to elucidate this in order to comprehend especially the asymptomatic and mild states of the infection, which appear to account for the majority of cases. Moreover, it is possible that mucosal immunity can be exploited for beneficial diagnostic, therapeutic, or prophylactic purposes. The findings from recent studies on mucosal immunity in COVID-19 can be used to develop effective vaccines and treatments that can effectively target both mucosal and systemic immune responses.

Post-traumatic stress disorder among healthcare workers during the COVID-19 pandemic in Italy: Effectiveness of an eye movement desensitization and reprocessing intervention protocol

Aim

The Coronavirus 2019 (COVID-19) pandemic represents one of the most catastrophic events of recent times. Due to the hospitals’ emergency situation, the population of healthcare workers was the most affected. Healthcare workers who were exposed to COVID-19 patients are most likely to develop psychological distress and post-traumatic stress disorder (PTSD). The present study aimed at investigating PTSD in a sample of Italian healthcare workers during this outbreak and to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) Therapy with this population.

Methods

A total of 744 healthcare workers were included. 587 healthcare workers were treated with EMDR, while the other 157 were not treated. Participants were asked to provide sociodemographic information; the post-traumatic symptomatology was evaluated through Impact of Event Scale-Revised (IES-R) and to investigate the level of intensity of emotional activation was used The Emotion Thermometer (THERMO) at two time points (pre-post treatment).

Results

The results obtained between EMDR treatment and non-EMDR treatment were evaluated on only 2 hospitals. Treatment group n = 68 vs. waitlist non-treatment group n = 157. All scores pre- and post-EMDR decreased significantly (p < 0.001) showing an evident effect of EMDR. The differences between pre- and post-treatment of the IES-R scores of subjects in which EMDR was performed as compared to the scores pre- and post-12 weeks of waiting list subjects in which it was not performed were significantly different (p < 0.001).

Limitation

The emergency situation did not provide an opportunity to explore further aspects that would have been important for research. One limitation is the use and analysis of only two standardized tests. In addition, other psychopathologies were not investigated as outcome measures. A limitation is the comparison of subjects treated online and de visu. Although the protocol used was the same, the mode of intervention may have influenced the results. In addition, the effectiveness of EMDR treatment was only evaluated at two time points (pre-post) with no possibility of follow-up and the lack of a control group.

Discussion/conclusion

The findings of the present study suggest that healthcare workers were at high risk of developing PTSD when confronted with COVID-19 outbreak and suggest the importance of psychological support during this humanitarian emergency.

Mental Health Inequities Amid the COVID-19 Pandemic: Findings From Three Rounds of a Cross-Sectional Monitoring Survey of Canadian Adults

Objectives: Adverse mental health impacts of the COVID-19 pandemic are well documented; however, there remains limited data detailing trends in mental health at different points in time and across population sub-groups most impacted. This paper draws on data from three rounds of a nationally representative cross-sectional monitoring survey to characterize the mental health impacts of COVID-19 on adults living in Canada (N = 9,061).

Methods: Descriptive statistics were used to examine the mental health impacts of the pandemic using a range of self-reported measures. Multivariate logistic regression models were then used to quantify the independent risks of experiencing adverse mental health outcomes for priority population sub-groups, adjusting for age, gender, and survey round.

Results: Data illustrate significant disparities in the mental health consequences of the pandemic, with inequitable impacts for sub-groups who experience structural vulnerability related to pre-existing mental health conditions, disability, LGBTQ2+ identity, and Indigenous identity.

Conclusion: There is immediate need for population-based approaches to support mental health in Canada and globally. Approaches should attend to the root causes of mental health inequities through promotion and prevention, in addition to treatment.

Teaching in Uncertain Times: Expanding the Scope of Extraneous Cognitive Load in the Cognitive Load Theory

The COVID-19 pandemic caused an unprecedented and highly threatening, constrained, and confusing social and educational environment, we decided to expand the traditional focus of the extraneous load in Cognitive Load Theory (CLT) acknowledging the psychological environment in which learning occurs. We therefore adapted and implemented principles of the CLT to reduce extraneous load for our students by facilitating their educational activities. Given previous empirical support for the principles of CLT, it was expected that the adoption of these principles might enable our students to cultivate attitudes and skills across multiple domains such as online learning and presentation technologies, implementing and maintaining a “classroom atmosphere” in a virtual environment, participating in discussions among large online groups of students, facilitating group work, providing virtual office hours for students, and proactively planning for upcoming semesters.

Academic Management in Uncertain Times: Shifting and Expanding the Focus of Cognitive Load Theory During COVID-19 Pandemic Education

Globally, the COVID-19 pandemic has forced medical education toward more "online education" approaches, causing specific implications to arise for medical educators and learners. Considering an unprecedented and highly threatening, constrained, and confusing social and educational environment caused by the COVID-19 pandemic, we decided to shift the traditional focus of the Cognitive Load Theory (CLT) from students to instructors. In this process, we considered recent suggestions to acknowledge the psychological environment in which learning happens. According to this fundamental fact, "Learning and instructional procedures do not occur in a situational vacuum." Following this assertion, we adapted and implemented principles of CLT to reduce the extraneous load for our faculty to facilitate continued scholarly activity and support the overall wellbeing of our faculty during these trying times. The adoption of these principles enabled our team to cultivate attitudes and skills across multiple domains, such as online presentation technologies, implementing and maintaining a "classroom atmosphere" in a virtual environment, encouraging discussion among large online groups of students, facilitating group work, providing virtual office hours, and proactively planning for subsequent sessions.

What Influences Physicians' Online Knowledge Sharing? A Stimulus-Response Perspective

During the COVID-19 pandemic, online health platforms and physicians' online knowledge sharing played an important role in public health crisis management and disease prevention. What influences physicians' online knowledge sharing? From the psychological perspective of stimulus-response, this study aims to explore how patients' visit and patients' consultation influence physicians' online knowledge sharing considering the contingent roles of physicians' online expertise and online knowledge sharing experience. Based on 6-month panel data of 45,449 physician-month observations from an online health platform in China, the results indicate that both patients' visit and patients' consultation are positive related to physicians' online knowledge sharing. Online expertise weakens the positive effect of patients' consultation on physicians' online knowledge sharing. Online knowledge sharing experience weakens the positive relationship between visit of patient and physicians' online knowledge sharing, and enhances the positive relationship between patients' consultation and physicians' online knowledge sharing. This study contributes to the literatures about stimulus-response in psychology and knowledge sharing, and provides implications for practice.

Exploring the Interrelationship between COVID-19 Phobia, Work–Family Conflict, Family–Work Conflict, and Life Satisfaction among School Administrators for Advancing Sustainable Management

This study aims to investigate the relationships between the COVID-19 phobia experienced by school administrators and their work–family conflict, family–work conflict, and life satisfaction. This descriptive research, designed according to the relational survey model, was conducted with the participation of 356 school administrators. The study data were collected through online questionnaires, and then t-test, ANOVA, correlation analysis, and simple linear regression analysis were employed for the statistical analyses. The results revealed that female school administrators experienced greater levels of COVID-19 phobia than their male peers and that COVID-19 phobia is felt more intensely in the psychological and social sub-dimensions. However, female school administrators’ life satisfaction levels were significantly higher than those of male school administrators. In the current study, it was determined that school administrators in the younger age group experienced greater levels of COVID-19 phobia and family–work/work–family conflict than their peers from other age groups. The results of this study revealed a positive and moderate relationship between school administrators’ COVID-19 phobia and their levels of both work–family and family–work conflict. The findings of the study offer significant implications for policy makers in education, showing the importance of developing strategies that will reduce the effects of the pandemic for a more sustainable and efficient employee performance.

Italian Community Psychology in the COVID-19 Pandemic: Shared Feelings and Thoughts in the Storytelling of University Students

This study investigated how young Italian people experienced the period of peak spread of COVID-19 in their country by probing their emotions, thoughts, events, and actions related to interpersonal and community bonds. This approach to the pandemic will highlight social dimensions that characterized contextual interactions from the specific perspective of Community Psychology. The aim was to investigate young people's experiences because they are the most fragile group due to their difficulty staying home and apart from their peers and because they are, at the same time, the most potentially dangerous people due to their urge to gather in groups. The research involved 568 university students, 475 females, and 93 males, with an average age of 21.82 years (SD = 4.836). The collected data were analyzed with the Grounded Theory Methodology, using the Atlas 8.0 software. From the textual data, representative codes were defined and grouped into 10 categories, which reflect the individuals' prosocial attitudes, behaviors, and values. These categories formed three macro-categories, called: "Collective Dimensions," which includes Connectedness, Solidarity, Italian-ness, Social Problems, and Collective Mourning; "Prosocial Orientation," which includes Trust and Hope; and "Collective Values," which includes Values of Freedom, Respect of Social Rules, and Civic-Mindedness. All these macro-categories are indicative of the shared feelings experienced by Italians during the first time of the pandemic. Further practical implications of these results will be discussed, including a consideration of the risk of developing distress and improving well-being, as well as promoting preventive behaviors.

Self-Perception of Changes in Routines in Adults and Older Adults Associated to Social Distancing Due to COVID-19-A Study in São Paulo, Brazil

COVID-19 is an acute respiratory illness with higher mortality in older adults. This condition is spread person-to-person through close contact, and among policies employed to decrease transmission are the improvement of hygiene habits and physical distancing. Although social distancing has been recognized as the best way to prevent the transmission, there are concerns that it may promote increased depression symptoms risk and anxiety, mainly in older adults. This cross-sectional study aimed to verify self-concept of social distancing in adults compared to older adults. All participants, over 18 years and residents of São Paulo state (Brazil), were invited to join this research study by a message application and answered an interdisciplinary questionnaire during the period from May 23 to June 23, 2020. The questions were divided into the following aspects: sociodemographic data, financial conditions, routine-related perception, perception of health, physical and emotional state, and eating habits. The younger adult group was composed of 139 participants, with a mean age of 43.15 years (±10.92), and the older adult group was composed of 437 participants with a mean age of 67.59 years (±6.13) of both sex. Changes in routine during the period of social distance were reported by 95% of adults and 96.8% of older adults, but adults indicated more significant alterations in routine. Although there was no difference between groups for several aspects, adults revealed greater alterations in sleep quality, evacuation frequency, and more difficulty to perform daily activities at home. Further studies are necessary to follow up the impacts of social distancing among adults and older adults in different socioeconomic contexts to better understand the long-term alterations and the necessity of interventions.

Analysis and Psychoeducational Implications of the Behavior Factor During the COVID-19 Emergency

This theoretical analysis seeks to contribute to three objectives within the context of the proposed Frontiers Research Topic: (1) delimit two levels of analysis in the present pandemic situation: medicine-epidemiology and behavioral psychology, still under-addressed. While medicine has its essential role on the biological side, psychology has a comparable role on the behavioral side. (2) Analyze the importance of behavioral-educational factors in the pandemic situation, using a precise theoretical model from educational psychology for this analysis. (3) Propose preventive, psychoeducational intervention strategies based on the previous analyses.

Factors Influencing Public Panic During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has been regarded as a public health emergency that caused a considerable degree of public panic (such as anxiety and insomnia) during its early stage. Some irrational behaviors (such as excessive search for information related to the pandemic and excessive hoarding of supplies) were also triggered as a result of such panic. Although there has been plenty of news coverage on public panic due to the outbreak, research on this phenomenon has been limited. Since panic is the main psychological reaction in the early stage of the pandemic, which largely determines the level of psychological adaptation, time of psychological recovery, and the incidence of PTSD, there exists a demand to conduct investigation on it. From a public governance perspective, the government's assessment of public panic may affect the efficiency and effectiveness of pandemic prevention and control. Therefore, it is of obvious practical significance to investigate public panic during the COVID-19 pandemic and analyze its influential factors. The self-compiled COVID-19 Social Mentality Questionnaire was used to collect data from a total of 16,616 participants online, and 13,511 valid responses were received. The results from the chi-square test showed that there were differences in gender, educational level, age, pandemic-related knowledge, self-efficacy, risk level, and objective social support. Furthermore, multiple linear regression analysis results showed that self-efficacy, gender, educational level, age, risk level, pandemic-related knowledge, and objective social support were significant predictors of public panic. Among the research variables, self-efficacy, gender, educational level, and age were negative predictors of panic while risk level, pandemic-related knowledge, and objective social support were positive predictors of panic.

No Evidence for a Decrease in Physical Activity Among Swiss Office Workers During COVID-19: A Longitudinal Study

PURPOSE

The COVID-19 lockdown interrupted normal daily activities, which may have led to an increase in sedentary behavior (Castelnuovo et al., 2020). The aim of this study was to investigate the effect of the COVID-19 pandemic on the level of physical activity among Swiss office workers.

METHODS

Office workers from two Swiss organizations, aged 18-65 years, were included. Baseline data from January 2020 before the COVID-19 pandemic became effective in Switzerland were compared with follow-up data during the lockdown phase in April 2020. Levels of physical activity were assessed using the International Physical Activity Questionnaire. Paired sample t-tests or Wilcoxon signed-rank test were performed for statistical analysis.

RESULTS

Data from 76 participants were analyzed. Fifty-four participants were female (71.1%). The mean age was 42.7 years (range from 21.8 to 62.7) at baseline. About 75% of the participants met the recommendations on minimal physical activity, both before the COVID-19 pandemic and during the lockdown. Weak statistical evidence for a decline in total physical activity in metabolic equivalent of task minutes per week (MET min/week) was found (estimate = -292, 95% CI from - ∞ to 74, p-value = 0.09), with no evidence for a decrease in the three types of activity: walking (estimate = -189, 95% CI from - ∞ to 100, p-value = 0.28), moderate-intensity activity (estimate = -200, 95% CI from - ∞ to 30, p-value = 0.22) and vigorous-intensity activity (estimate = 80, 95% CI from - ∞ to 460, p-value = 0.74). Across the three categories "high," "moderate," and "low" physical activity, 17% of the participants became less active during the lockdown while 29% became more active.

CONCLUSION

The COVID-19 pandemic did not result in a reduction in total physical activity levels among a sample of Swiss office workers during the first weeks of lockdown. Improved work-life balance and working times may have contributed to this finding.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, NCT04169646. Registered 15 November 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646.

Supporting Holistic Wellbeing for Performing Artists During the COVID-19 Pandemic and Recovery: Study Protocol

The COVID-19 pandemic resulted in the abrupt closure of circus schools, venues, and companies, introducing a myriad of novel stressors. Performers and students must now attempt to maintain their technical, physical, artistic, creative, and cognitive abilities without in-person support from their coaches and must manage the isolation from their training and performing spaces. For circus artists, the transposition of the work space to a home environment is not possible, which creates novel stressors that could lead to the exacerbation and escalation of mental health issues. The purpose of this study is to develop, implement and evaluate a holistic interventional program based on the socio-ecological model of resilience and operationalized through physical literacy. This will be a prospective longitudinal study with a retrospective comparison to data from a similar student cohort pre-pandemic. Interventions were designed using a population-specific, participant-based developmental model within a knowledge translation framework. The interventional program includes group webinars, small group information sessions, and one-on-one Zoom meetings, in addition to the distribution of electronic educational materials. The interventions will holistically provide psychological, physical, social, technical, artistic, and creative supports. Resources will be deployed throughout the closure period and through recovery, as transitions to return to training after prolonged hiatus will magnify known psychological and physical difficulties. Repeated, longitudinal assessment of students will be utilized to track changes over time at key transitions in the pandemic and school year and will be compared to a pre-pandemic school year. The framework for this program will be translatable to other performing arts and high-performance contexts. The program has implications for the mental health and overall wellbeing of artists and for cultural and economic recovery of the industry.

SARS-CoV-2 and Asbestos Exposure: Can Our Experience With Mesothelioma Patients Help Us Understand the Psychological Consequences of COVID-19 and Develop Interventions?

Since its emergence, the novel coronavirus disease of 2019 (COVID-19) has had enormous physical, social, and psychological impacts worldwide. The aim of this article was to identify elements of our knowledge on asbestos exposure and malignant mesothelioma (MM) that can provide insight into the psychological impact of the COVID-19 pandemic and be used to develop adequate interventions. Although the etiology of Covid-19 and MM differs, their psychological impacts have common characteristics: in both diseases, there is a feeling of being exposed through aerial contagion to an "invisible killer" without boundaries that can strike even the strongest individuals. In both cases, affected persons can experience personality dysfunction, anxiety, depression, and posttraumatic symptoms; helplessness, hopelessness, and projection of destructive thoughts onto external forces often emerge, while defense mechanisms such as denial, splitting, repression, and reduced emotional expression are used by individuals to contain their overwhelming anxieties. We believe that in both diseases, an integrated multidimensional intervention offered by hospitals and other public health services is the most effective approach to alleviating patients' and caregivers' psychological distress. In particular, we emphasize that in the context of both MM and COVID-19, Brief Psychoanalytic Group therapy can help patients and caregivers attribute meaning to the significant changes in their lives related to the experience of the disease and identify adaptive strategies and more realistic relational modalities to deal with what has happened to them. We also highlight the importance of developing a surveillance system that includes individual anamnestic evaluation of occupational risk factors for COVID-19 disease.

Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy

Background

Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown.

Methods

By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10–1st phase to May 4–2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study–sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales–21 Items (DASS-21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis.

Results

A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep–wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression.

Conclusion

This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID-19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak.

Resilience Contributes to Low Emotional Impact of the COVID-19 Outbreak Among the General Population in Italy

BACKGROUND

The COVID-19 outbreak is severely affecting the overall mental health with unknown psychological consequences. Although a strong psychological impact is possible, scant evidence is available to date. Past studies have shown that resilience decreases the negative effects of stress. This study aimed to examine depression, anxiety, and stress among the Italian general population during the phase characterized by lockdown, and to investigate the role of resilience as a potential predictor.

METHODS

A total sample of 6,314 Italian people participated in this study. Participants were recruited between March 29 and May 04 2020 through an online survey. The Depression Anxiety Stress Scales-21 (DASS-21) and the Resilience Scale (RS) were administered. Demographic data and lockdown related information were also collected. A correlational analysis was carried out to examine relationships between psychopathological domains and resilience. Three hierarchical regression analyses were conducted using the depression, anxiety, and stress as dependent variables and the resilience as independent variable controlling for age, gender, and education. COVID-19 specific variables were also included in the three regression analyses. A further exploratory analysis was carried out to examine which aspects of resilience predict depression, anxiety, and stress.

RESULTS

The prevalence of moderate to extremely severe symptoms among participants was 32% for depression, 24.4% for anxiety, and 31.7% for stress. The sample mean scores on depression, anxiety, and stress were higher than the normal scores reported in the literature. Results of correlational analysis showed that resilience factors, such as meaningfulness, self-reliance, existential aloneness, and equanimity, are inversely associated with depression, anxiety, and stress. Results of regression analyses indicated that resilience was statically significant in predicting depression, anxiety, and stress. Geographic area of residence and infected acquaintances were also significant predictors. Regarding the resilience factors, results revealed that meaningfulness, perseverance, and equanimity were statistically significant in predicting all the DASS-21 scales.

CONCLUSION

About a third of respondents reported moderate to extremely severe depression, anxiety, and stress. The present study suggests that psychological resilience may independently contribute to low emotional distress and psychological ill-being. These findings can help explain the variability of individual responses during the COVID-19 outbreak.

The Unprecedented Movement Control Order (Lockdown) and Factors Associated With the Negative Emotional Symptoms, Happiness, and Work-Life Balance of Malaysian University Students During the Coronavirus Disease (COVID-19) Pandemic

Background and Aims: Malaysia's first Movement Control Order (MCO) or "lockdown" was in place for 6 weeks to curb the spread of coronavirus disease (COVID-19). Consequently, all universities were forced to close temporarily with abrupt changes to teaching and learning activities. However, there has been a lack of consensus regarding students' actual psychological status and mental health during the MCO implementation. This study investigates the link, state, and differences of negative emotional symptoms, happiness, and work-life balance among university students during the COVID-19 pandemic. Methodology: This study recruited 1,005 university students across Malaysia. Data was collected online using Qualtrics to measure negative emotional symptoms (The Depression, Anxiety, and Stress Scale), happiness (The Oxford Happiness Inventory), and work-life balance (Work-Family Conflict Scale). All data was analyzed using SPSS version 25 and AMOS version 26 using T-test, ANOVA, logistic regression analyses, and path analysis method. Findings: Findings indicated that 22, 34.3, and 37.3% of the university students scored moderate to extremely severe levels of stress, anxiety, and depression symptoms, respectively. Half scored rather happy or very happy (50%) for happiness levels. Meanwhile, 50.4 and 39.4% scored high to very high levels of work-to-family and family-to-work conflict. Significant differences in stress, anxiety, depression, happiness, work-family conflict, and family-work conflict were recorded across different demographic factors. Happiness was found to be a protective factor with a lesser likelihood of experiencing severe stress (OR = 0.240, 95% CI: 0.180, 0.321), anxiety (OR = 0.336, 95% CI: 0.273, 0.414), and depression (OR = 0.121, 95% CI: 0.088, 0.165) with higher happiness levels. Higher score of work-to-family conflict contributes to greater odds of having severe levels of anxiety (OR = 1.453, 95% CI: 1.161, 1.818). While greater likelihood of developing severe stress (OR = 1.468, 95% CI: 1.109, 1.943) and severe anxiety (OR = 1.317, 95% CI: 1.059, 1.638) under increasing score of family-to-work conflict. Besides, happiness is found to negatively linked with lower negative emotional symptoms, while work-family conflict and family-work conflict are positively linked with higher negative emotional symptoms. Conclusion: Lockdown implementation during the COVID-19 pandemic appears to have a significant impact on university students' negative emotional symptoms, happiness, and work-life balance. Happiness was found to be a protective factor while the state of work-life balance is a risk factor that can predict students' negative emotional symptoms.