Online University Counselling Services and Psychological Problems among Italian Students in Lockdown Due to Covid-19

Comparing mental health and well-being of US undergraduate and graduate students during the early stages of the COVID-19 pandemic

Objective: This study explored how COVID-related mental health and well-being varied between undergraduate and graduate students. Relationships with physical health behaviors were also examined. Participants: Undergraduate (n = 897) and graduate (n = 314) students were recruited from three US universities between mid-April and late-May 2020. Methods: Participants in this cross-sectional survey self-reported perceived stress, financial stress, resilience, repetitive negative thinking, mood, anxiety, diet, sleep, and physical activity using validated instruments. Results: Undergraduate students reported more perceived stress, more repetitive negative thinking, less positive mood, and less support from professors than graduate students. Perceived stress, repetitive negative thinking, negative mood, and anxiety increased among all students (p < .05 for all). Correlations between mental health outcomes and physical health behaviors were weak to moderate (r = .08 to .49). Conclusions: College students, particularly undergraduates, perceived negative mental health impacts during COVID. Creative approaches for meeting student needs are necessary.

Predictors of well-being, future anxiety, and multiple recurrent health complaints among university students during the COVID-19 pandemic: the role of socioeconomic determinants, sense of coherence, and digital health literacy. An Italian cross-sectional study

The pandemic deeply changed young adults' life. Lockdown period and the social restrictions dramatically affected university students' mental health. The aim of our cross-sectional study was to describe psychological well-being, future anxiety (FA), and health complaints (HCs) in a sample of 3,001 students of the University of Florence in the middle of the first two pandemic waves. We assessed the role of subjective social status, chronic diseases, sense of coherence (SoC), and digital health literacy (DHL) as predictors of psychological well-being, FA, and HCs. Students expressed high levels of FA and reported being disturbed by not being able to achieve their desired future goals. About 40% reported a low or a very low well-being and 19.1% experienced two or more subjective health complaints more than once a week. The likelihood of having a better mental health status significantly increased with increasing SoC and among males. Subjective Social Status proved to be a predictor for FA. Enhancing SoC could improve the health status of the university students during the pandemic and beyond.

Fuzzy clustering algorithm for university students' psychological fitness and performance detection

Students' psychological fitness is unavoidable, hindering personal development, social interactions, peer influence, and adolescence. Academic stress may be the most dominant factor affecting college students' mental well-being. Therefore, improving the monitoring of mental health issues among college students is a vital topic for study. However, identifying the student's stress level is challenging, leading to uncertainty. Hence, this paper suggests Heuristic Fuzzy C-means Clustering Algorithm (HFCA) for analyzing college students' stress levels, psychological well-being and academic performance detection. The data are collected from the Kaggle stress dataset for predicting student mental health. This study investigates the psychological factors affecting students' academic performance using the suggested HFCA. Students' performance may be predicted using the Fuzzy Cognitive Map (FCM) in this study. This study used fuzzy clustering algorithms to discover the most crucial aspects of student success, such as student involvement and satisfaction. A better understanding of the risk factors for and protective factors against poor mental health can serve as the basis for developing policies and targeted interventions to prevent mental health problems and guarantee that at-risk students can access the help they need. The experimental analysis shows the proposed method HFCA to achieve a high student performance ratio of 96.7%, cognitive development ratio of 97.2%, student engagement ratio of 97.5% and prediction ratio of 95.1% compared to other methods.

The Experiences of Australian School Mental Health Professionals during COVID-19 Lockdowns

Young people have emerged as one of the most impacted groups from the COVID-19 pandemic and related restrictions to daily activities, with disruptions to schooling, social interactions, and connections. Simultaneously, students' access to school mental health professionals were restricted or modified. The aim of this paper was to identify how school mental health professionals supported and addressed the mental health needs of young people during COVID-19 restrictions in Australia. School mental health professionals were surveyed during the 2020 lockdowns using a questionnaire designed by researchers in the United States of America. The innovations school mental health staff adopted to support students during lockdowns and remote learning were presented, including telehealth services, digital resources, and the online training and support they received/provided. The barriers and facilitators to providing counselling and assessment services during lockdowns were identified, including issues with providing psychometric assessments during remote learning, and ethical concerns when delivering remote counselling to students. Recommendations have been included, which address how school mental health professionals could be supported to assess and treat young people during future pandemics and school restrictions.

The effect of COVID-19 restrictions on sleep quality of university students and variables predicting sleep quality

BACKGROUND/AIM

The COVID-19 pandemic has created a long period of stress for people worldwide and has significantly affected sleep duration. The pandemic revealed new stress factors that are likely to affect sleep. Uncertainty is a factor that leads to anxiety and depression, which affects sleep. It should also be noted that reductions in sleep quality rather than sleep duration are associated with negative consequences on mental health. This study aims to investigate online that how this situation affected university students.

MATERIALS AND METHODS

This research, with a descriptive study design, was conducted in Turkey between June 01, 2021 and July 30, 2021. The sample included 604 people who accepted voluntary participation, chosen by the random selection method. In the study, sociodemographic information form, Pittsburgh sleep quality index (PSQI), morningness-eveningness questionnaire scale (MEQ Scale), Beck depression inventory (BDI), and Beck anxiety inventory (BAI) were used as data collection tools. Pearson correlation analysis was utilized to examine the relationship between the scales. Multiple regression analysis was performed to investigate the role of morningness-eveningness, anxiety, depression, and insomnia severity on sleep quality.

RESULTS

Sleep quality was negatively correlated with morningness-eveningness scores (r = -0.32, P < 0.01), and positively and significantly related with anxiety (r = 0.43, P < 0.01), depression (r = 0.40, P < 0.01) and insomnia severity (r = 0.55, P < 0.01). According to regression coefficients, while anxiety (β = 0.041, P < 0.001) and insomnia severity scores (β = 0.226, P < 0.001) positively predicted sleep quality, depression did not predict it significantly (β = 0.009, P > 0.05). A significant difference was found in sleep quality according to morning, evening, and intermediate types (F = 27.401, P < 0.001).

CONCLUSION

Events related to the COVID-19 pandemic are associated with reduced sleep quality in connection with increasing negative moods. Considering the importance of sleep for a healthy life, efforts should be made to raise awareness about this issue and to provide psychological help to affected individuals.

Resilience and Experience of the COVID-19 Pandemic among Italian University Students: A Mixed-Method Study

A vast amount of literature has highlighted that restrictions imposed by the COVID-19 pandemic, such as lockdowns and the resulting interruption of face-to-face academic activities, strongly disrupted students' daily routine and undermined their well-being. Through a mixed method approach, this study was aimed at investigating the association between students' experience of the health emergency and their resilience levels during the first pandemic outbreak. Between April and May 2020, 421 Italian university students attending Health Sciences, Humanities, and Political Sciences courses completed the Resilience Scale for Adults (RSA), provided narratives about the emergency by answering an open-ended question, and filled out a demographic questionnaire. Results showed that narratives about community/society issues were by far the most recurrent ones across disciplinary areas, while a significantly higher percentage of students from Humanities focused on study/university. Health Sciences students were more likely to provide narratives concerning social commitment, and they reported significantly higher resilience levels than Humanities students. A higher percentage of students with moderate resilience focused their narratives on the study/university domain, compared to students with high resilience. Findings suggest the importance of supporting students' resilience to counterbalance their academic concerns in both times of crisis and ordinary times.

Psychological and physical health behavior deviations in students amidst the COVID-19 pandemic

Objective: This study sought to understand how the pandemic impacted mental and physical health behaviors in University students. Methods: Undergraduate and graduate students were asked to answer questions on depression, anxiety, stress, sleep quality, and physical activity "prior to" and "during" the shutdown. Results: 457/960 (47.6%) completed the entire survey. Paired samples t-tests showed significant change in mental and physical health behaviors over time. Hierarchical regression models indicated that negative experiences during the shutdown were associated with depression, anxiety, stress, and sleep quality (all p's < .001), but not time spent exercising or sedentary behavior. In addition, positive experiences during the shutdown acted as a buffer. Conclusion: The COVID-19 pandemic shutdown negatively impacted University students. Significant mental and physical health consequences were observed. These effects may linger long past the re-opening of society, and it may be prudent to prepare for additional demand on campus resources.

Sociodemographic and Digital Education Factors Are Associated to General Health, Coping Strategies, and Academic Outcomes of Undergraduate Students during the Post-Pandemic Period

The COVID-19 pandemic suddenly and forever changed the lives of many undergraduate students around the globe, forcing them to switch to online learning while undergoing social confinement within their homes. It is now well-established that this prolonged period of uncertainty impacted students’ well-being, health, and academic achievement. However, how student-related factors, such as coping strategies as well as sociodemographic, contextual, and technological variables, are linked to digital education factors is currently less understood. Using multiple regression analysis, this study investigates the results of an online questionnaire administered to students from two universities in southern Italy, differing in positioning and size, as well as policies and attitude towards digital learning. The results of this study show the positive effects of expertise with digital devices and university digital learning policies on students’ perceived general health. Conversely, isolation and lack of relational connectedness negatively impacted students’ health. Furthermore, this study highlights the role of different coping strategies, demonstrating that active forms of coping have a positive effect on students’ health, whereas avoidance strategies have the opposite effect. Taken together, this study provides crucial links between the many factors influencing students’ experience with online learning and health, and provides useful indications to promote the uptake of and adaptation to online learning.

Responding to the COVID-19 public health emergency: The usefulness of an online brief psychological intervention with Italian university students

The COVID-19 pandemic has brought about new stressors on university students, with a negative impact on their mental health and well-being. The purpose of this study was to examine the usefulness of a brief psychodynamically oriented intervention on general functioning by investigating changes in symptoms of depression, anxiety, hopelessness, and burnout. The sample was comprised of 67 university students (22.4% males), with a mean age of 23.27 (standard deviation (SD) = 3.27), who asked for psychological help at a psychological university service. Pre- and posttreatment data showed a significant improvement in general functioning and symptom reduction due to the psychological intervention. The mean change was very high for depression (d = 1.11) and high for general functioning (d = 0.70) and anxiety (d = 0.69). Our findings showed the importance of considering university students a vulnerable population that requires specific services within the university context and underlined the fact that mental-health-promotion policies should be extensively implemented.

Evaluation of Expressive Arts Therapy on the Resilience of University Students in COVID-19: A Network Analysis Approach

As an alternative to traditional verbal counselling, expressive arts therapy has been shown to be an effective method of mental health care, particularly when dealing with stressful public interactions, such as those associated with COVID-19. However, few studies have been conducted to determine the efficacy of expressive arts therapy on the resilience of psychologically exposed university students during COVID-19. Furthermore, since network analysis appears to be a popular approach in psychological research, it has not been used in recent intervention studies for resilience. As a result, the current study utilized a network analysis approach to determine the efficacy of expressive arts therapy on the resilience of university students during the COVID-19 pandemic. A total of 263 students in a comprehensive university in China were selected for the therapy group between March and November 2021. In a pre-post design, students’ resilience was assessed using the Resiliency Scale for University Students (RSUS). The extended Bayesian information criteria (EBIC) and graphical LASSO were used to estimate and define paired resilience networks, and the strength, betweenness, and closeness indices were utilized to determine the centrality of the six facets of resilience. Additionally, we verified the stability and accuracy. It was discovered that significant differences appeared between the paired networks before and after expressive arts therapy. Facets of self-efficacy, self-acceptance and problem-solving in resilience were notably improved after the therapy, with the variable of emotional stability sustained at the mean level. Meanwhile, the network analysis has highlighted the central variable of self-efficacy in the pre-intervention and support from friends in the post-intervention. The connectivity among the components of problem solving, support from friends, and support from family was enhanced, with support from friends playing the role of hub nod in the following network. By utilizing a network analytic approach, expressive arts therapy can be more targeted in intervening in resilience mechanisms. As a proxy for efficacious problem-solving, intervention should be calibrated to the cultivation of social support networks, especially in the support from friends.

Relationship between Psychological Distress, Basic Psychological Needs, Anxiety, Mental Pressure, and Athletic Burnout of Chinese College Football Athletes during the COVID-19 Pandemic

The rapid spread of the COVID-19 pandemic in early 2020 poses a significant threat to mental health, which may lead to psychological stress in a number of individuals. Athlete burnout is a common psychological phenomenon that has a negative influence on their sports career. The main purpose of this study was to evaluate the relationship between psychological distress and athletic burnout among Chinese college football athletes during the COVID-19 pandemic, and the mediating role of basic psychological needs, anxiety and mental pressure. In an online cross-sectional survey conducted in February 2022, the team coaches sent an electronic questionnaire to college football athletes. Participants completed questionnaires on relevant variables. Pearson correlation analysis and mediation effect analysis were carried out by using SPSS software and its plug-in process V3.3. The study included 672 participants and the results showed that: (1) psychological distress, basic psychological needs, anxiety, mental pressure and athletic burnout were significantly pairwise correlated, (2) mental pressure, anxiety and basic psychological needs play a mediating role between psychological distress and athletic burnout respectively, and (3) basic psychological needs and anxiety, basic psychological needs and mental pressure, anxiety and mental pressure, as well as mental pressure, anxiety and basic psychological needs respectively play a chain mediating role between psychological distress and athletic burnout. In conclusion, psychological distress during the COVID-19 pandemic is an important factor leading to athletic burnout among Chinese college football athletes and may further affect the level of athletic burnout through basic psychological needs, anxiety and mental pressure. The government and schools should strengthen the recognition of these factors in order to improve the situation of athletic burnout among Chinese college football athletes.

The reality of E-counseling services in the light of Digital learning from the point of View of Teachers in Jordan

This study aims to investigate the reality of e-counseling services in the light of digital learning from the perspective of teachers in Jordan. The sample of the study consisted of (348) male and female teachers at Rusaifa Education Directorate in 2021. The scale of the counseling services for this study was created by the researchers, where the validity and reliability of the scale were approved, and the appropriate statistical procedures were used. The study reached some statistical results regarding e-counseling services in the light of digital learning from the perspective of teachers in Jordan. Results revealed that the arithmetic averages of the reality of e-counseling services have an intermediate degree at the overall level, and each dimension has an intermediate degree, too. The prevention dimension took the first place, followed by the social dimension, the moral dimension, the professional dimension, the educational dimension, and lastly, the technical dimension, respectively. The results revealed that there are no statistically significant differences at the level of significance (α ≤ 0.05) at the overall level. The level of each dimension of the scale is attributed to the variables of gender and one's years of experience.

Loneliness and Optimism among Polish Nursing Students during the COVID-19 Pandemic: The Mediatory Role of Self-Efficacy

(1) The COVID-19 pandemic is a global epidemic crisis situation with negative health consequences. This study aimed to determine the mediatory role of self-efficacy in correlations between dispositional optimism and loneliness (both general loneliness and social and emotional loneliness) among Polish nursing students during the COVID-19 pandemic. (2) The study involved 894 students from six Polish universities. A diagnostic survey was used as the research method, and the Scale for the Measurement of Loneliness Scale (DJGLS), Life Orientation Test (LOT-R), and the Generalized Self-Efficacy Scale (GSES) were used to collect data. (3) The mean subject age was 20.73 years (SD = 1.81). More than half (51.01%) of the respondents scored high on the GSES scale, indicating an individual's belief in the self-efficacy in coping with difficult situations and obstacles. However, 40.60% scored low on the LOT-R scale, indicating that the respondents were pessimistic. The mediation analysis revealed that self-efficacy plays a partial mediatory role in correlations between dispositional optimism and loneliness in general, social and emotional loneliness. (4) It is important to undertake loneliness prophylactic and prevention activities among nursing students and to develop personal resources, i.e., optimism and self-efficacy, to effectively offset the effects of the COVID-19 pandemic.

Loneliness and Satisfaction with Life among Nursing Students in Poland, Spain and Slovakia during the COVID-19 Pandemic

(1) The COVID-19 pandemic poses threats to human life and health around the world. This study attempts to determine the correlation between loneliness and satisfaction with life among nursing students in Poland, Spain and Slovakia and to seek predictors of social and emotional loneliness among the students. (2) A total of 756 nursing students from Poland, Spain and Slovakia took part in the study. A diagnostic survey was applied as the research method, and the data were collected with the sense of loneliness measurement scale (de Jong Gierveld Loneliness Scale–DJGLS) and the Satisfaction with Life Scale (SWLS). (3) The mean age of the participants was 21.20 years (SD = 1.97). A correlation analysis revealed statistically significant, negative correlations, with an average and high strength, between the general sense of loneliness and its components (social loneliness and emotional loneliness) and satisfaction with life among students in Poland, Spain and Slovakia. A regression analysis showed one’s satisfaction with life to be a predictor of a sense of loneliness among nursing students in Poland, Spain and Slovakia in the second year of the COVID-19 pandemic. (4) Students with a stronger sense of loneliness also feel lower life satisfaction. It is important to take preventive and prophylactic actions concerning loneliness among students during and after the COVID-19 pandemic.

Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period

BACKGROUND

The COVID-19 pandemic has increased online counselling interventions, including those aimed at university students. The principal aim of the study is to evaluate the effectiveness of the online counselling intervention during the COVID-19 pandemic, also with regards to the effectiveness of the face-to-face intervention.

METHODS

34 students (Mean age = 23.74; Female = 27) who requested online university counselling during COVID-19 have been compared with 81 (Mean age = 22.8; Female = 60) students who requested university face-to-face counselling before the pandemic. The psychopathological problems were assessed with the Symptom Checklist 90 Revised, attachment styles with the Attachment Style Questionnaire, adverse childhood experiences with Adverse Childhood Experiences Questionnaire, and life satisfaction with the Life Satisfaction Scale.

RESULTS

At the pre-intervention phase, psychological distress was similar in both groups with no differences in the General Severity Index of the SCL-90 R, and there were no significant differences for secure/insecure attachment, adverse childhood experiences, and life satisfaction. The online counselling intervention during the pandemic was effective in reducing psychological distress scales as depression (p = .008), obsessive-compulsive (p = .008), interpersonal sensitivity (p = .005), and anxiety (p = .011), and in the total scale of the SCL-90 R (p = .017). The face-to-face counselling intervention was effective in reducing psychological distress in all subscales and in the total scale of the SCL-90 R (p = .000) and in increasing the level of life satisfaction (p = .023). Attachment style did not moderate the effectiveness of the online and face-to-face interventions.

CONCLUSIONS

Students seeking counselling, both before and during the pandemic, show similar levels of psychological distress. The online counselling intervention was almost as effective as face-to-face counselling intervention with respect to psychological distress; it was not effective in increasing life satisfaction.

Life Design Counseling: Theory, Methodology, Challenges, and Future Trends

With the rapid development of society and the dramatic change of environment, previous career counseling focusing on personal choice has been difficult to meet individuals’ needs. It is very meaningful and valuable to introduce the ideology of Life Design Counseling (LDC). In this mini review, we introduce and analyze the theory and methodology of LDC. This review puts forward challenges in the field of LDC, including the lack of attention to clients from multiple backgrounds and professional counselors, the lack of diversified methods in the intervention process, and the lack of diversified research. The theoretical research, practical research, and the integration of theory and practice of LDC still need to be further concerned by researchers.

The relationship between schizotypal personality features and mind wandering among college students during COVID-19 pandemic: A moderator of depression

INTRODUCTION

Although the impact of the COVID-19 pandemic on people's mental health has been well documented in many studies, the schizotypal personality features in the general population have not received sufficient attention.

METHODS

Study 1 is a longitudinal study tracking changes in schizotypal personality features among college students during the COVID-19 pandemic. A total of 153 Chinese college students were assessed using the Schizotypal Personality Questionnaire. Study 2 explored the relationship between schizotypal personality features, mind wandering, and depression. A total of 557 college students completed the Schizotypal Personality Questionnaire, the Beck Depression Inventory, and the Mind-Wandering Questionnaire during the COVID-19 pandemic.

RESULTS

Study 1 results showed that the scores from later stages in the pandemic were significantly higher than those from the initial stages on each dimension of schizotypal personality, which means that the schizotypal personality features became more obvious during the COVID-19 pandemic. Study 2 results showed that there was a positive correlation between schizotypal personality features, depression, and mind wandering.

DISCUSSION

Depression played a moderating role in the relationship between schizotypal personality features and mind wandering. The schizotypal personality features of college students increase during COVID-19; it has a positive relationship with mind wandering; depression moderates the relationship. We discussed these findings and provided some suggestions about future research.

Emotions and Motivations Underlying Adherence to the Anti-COVID-19 Vaccination Campaign: A Survey on a Sample of Italians under 30 Years

BACKGROUND

In Italy, the under-30 age category was the one that joined the anti-COVID-19 vaccination campaign in an important way. This study investigates the emotional states and motivations underlying joining the anti-COVID-19 vaccination campaign.

METHODS

A questionnaire consisting of SF-12, STAI Y, and open questions was administered to investigate the state of health, the state of anxiety, and motivational states of the participants.

RESULTS

Of the sample, 80.7% were vaccinated at the first call, deeming the action important to combat the infection. However, 48.2% stated that they were quite worried about the problems related to the pandemic, 37.3% feared being directly infected, and 43.4% were worried about the health of relatives and friends.

CONCLUSIONS

The positive impact that the vaccination campaign has had on the under-30 category is very significant for the immunization process, which is of fundamental importance for fighting the pandemic, so the "benefits" outweigh the "risks" related to the COVID-19 vaccine.

The Opportunities and Challenges of the First Three Years of Open Up, an Online Text-Based Counselling Service for Youth and Young Adults

We present the opportunities and challenges of Open Up, a free, 24/7 online text-based counselling service to support youth in Hong Kong. The number of youths served more than doubled within the first three years since its inception in 2018 in response to increasing youth suicidality and mental health needs. Good practice models are being developed in order to sustain and further scale up the service. We discuss the structure of the operation, usage pattern and its effectiveness, the use of AI to improve users experience, and the role of volunteer in the operation. We also present the challenges in further enhancing the operation, calling for more research, especially on the identification of the optimal number of users that can be concurrently served by a counsellor, the effective approach to respond to a small percentage of repeated users who has taken up a disproportional volume of service, and the way to optimize the use of big data analytics and AI technology to enhance the service. These advancements will benefit not only Open Up but also similar services across the globe.

Depressive symptoms in higher education students during the first wave of the COVID-19 pandemic. An examination of the association with various social risk factors across multiple high- and middle-income countries

Higher-education students face substantial risks for developing depressive symptoms during the COVID-19 pandemic or experiencing exacerbated pre-existing depressive symptoms. This study uses data from the COVID-19 International Student Well-Being Study, which collected data through a non-representative convenience sample in 125 higher-education institutions (HEI) across 26 high- and middle-income countries (N: 20,103) during the first wave of the COVID-19 pandemic. It describes the prevalence of depressive symptoms in higher-education students. We find substantial cross-national variation in depressive symptoms, with lowest mean levels established in the Nordic countries and France, while highest mean levels of depressive symptoms were found in Turkey, South Africa, Spain and the USA. Elevated risk for depressive symptoms was found in female students, students with fewer social support resources and in a more disadvantaged socioeconomic position, and students with a migrant background. COVID-19 related stressors, such as reduced social contact, increased financial insecurity, and academic stress explained a relatively larger proportion of the variance in depressive symptoms compared to non-COVID-19 related stressors. This finding shows that not the pandemic itself, but rather the secondary effects of the pandemic relate to students' mental health. Our results enable HEIs to be better equipped to target groups that are particularly at risk during a pandemic.

Taking a Leap of Faith: A Study of Abruptly Transitioning an Undergraduate Medical Education Program to Distance-Learning Owing to the COVID-19 Pandemic

The COVID-19 pandemic has forced universities worldwide to immediately transition to distance-learning. Although numerous studies have investigated the effect of the COVID-19 pandemic on universities in the Middle East, none have reflected on the process through which medical education programs for health professions underwent this transition. This study aimed to elucidate the rapid transition to distance-learning of an undergraduate medical program at the College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences (Dubai, United Arab Emirates), owing to the COVID-19 pandemic. An action research approach constituted the foundation of this collaborative effort that involved investigations, reflections, and improvements of practice, through ongoing cycles of planning, acting, observing, and reflecting. Efforts of transitioning to distance-learning were grouped into four interrelated aspects: supporting faculty members in delivering the program content, managing curriculum changes, engaging with the students to facilitate distance-learning experiences, and conducting web-based assessments. Challenges included the high perceived uncertainty, need for making ad hoc decisions, lack of experiential learning and testing of clinical skills, and blurring of work-life boundaries. Our preliminary findings show the successful generation of a strong existing digital base, future prospects for innovation, and a cohesive team that was key to agility, rapid decision-making, and program implementation.

Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study

BACKGROUND

University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention.

OBJECTIVE

The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students.

METHODS

In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale-Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention.

RESULTS

Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot.

CONCLUSIONS

This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

Psychological Distress among Italian University Students Compared to General Workers during the COVID-19 Pandemic

The COVID-19 pandemic induced numerous changes in the daily life of every individual, with important social, economic, and psychological consequences. Particularly, the psychological impact encountered among students might be affected by social isolation, concern for personal health and for the health of family members and friends, and uncertainty about academic progress. The present study aimed to investigate the psychological impact of the COVID-19 outbreak on Italian university students compared to general workers. The responses of 956 participants (478 university students and 478 workers) were included in the final dataset. Participants were asked to provide sociodemographic and occupation-related information, and to complete: (1) COVID-19-related questions; (2) health-related visual analogue scales; (3) State-Trait Anxiety Inventory-Form Y1 (STAI Y1); and (4) the Beck Depression Inventory (BDI-II). Results of comparisons between university students and general workers revealed that the former reported higher levels of anxiety and depressive symptoms. Furthermore, regression analyses showed that in university students, gender, health evaluation, and health concern and gender, educational level, and health evaluation significantly predicted anxiety and depressive symptoms, respectively. Taken together these findings suggest that specific factors could predispose University students to a high risk of developing mental health symptoms as a consequence of the COVID-19 pandemic.