|Year : 2021 | Volume
| Issue : 3 | Page : 87-92
Impact of COVID Pandemic on Psychological Health and Academics of Undergraduate Students
Aarati B Pokale, Aditya A Godbole, Rupeshkumar Deshmukh
Department of Community Medicine, Bharati Vidyapeeth (DTU) Medical College, Pune, Maharashtra, India
|Date of Submission||08-Mar-2020|
|Date of Decision||22-Jun-2021|
|Date of Acceptance||25-Jun-2021|
|Date of Web Publication||11-May-2022|
Aarati B Pokale
Department of Community Medicine, Bharati Vidyapeeth (DTU) Medical College, Pune - 411 043, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Novel coronavirus disease (COVID-19) first caused an outbreak in Wuhan, China in December 2019. After its spread in India, lockdown was initiated which forced students to continue their education through online learning platforms. Aim: The aim of the study was to assess the impact of the pandemic on psychological health and academics of undergraduate students in India. Settings and Design: Online survey conducted among undergraduate students. Materials and Methods: Cross-sectional study was conducted using three validated scales to assess fear, anxiety and depression (Numeric Rating Scale, Hamilton Anxiety Scale A, and Zung Self-Rating depression Scale). Statistical Analysis: Data were analyzed using the SPSS software version 25.0. The Chi-square test was used for the comparison of variables with demographic characteristics and regression analysis was done to calculate anxiety and depression scores. Results: Online survey was filled by 721 undergraduate students from across India. Moderate scores of fear, anxiety, and depression were reported to be 43.3%, 23.4%, and 76.4%, respectively. A total of 82.5% of respondents reported that the pandemic had affected their studies with disturbed routine, loss of concentration, and eye strain being the major causes. Conclusions: Mental health of students should be assessed and psychological guidance should be provided during the pandemic. Online teaching curriculum should consider all the stressors faced by students and planned accordingly.
Keywords: Academics, pandemic, psychological impact, undergraduate students
|How to cite this article:|
Pokale AB, Godbole AA, Deshmukh R. Impact of COVID Pandemic on Psychological Health and Academics of Undergraduate Students. D Y Patil J Health Sci 2021;9:87-92
|How to cite this URL:|
Pokale AB, Godbole AA, Deshmukh R. Impact of COVID Pandemic on Psychological Health and Academics of Undergraduate Students. D Y Patil J Health Sci [serial online] 2021 [cited 2022 May 27];9:87-92. Available from: http://www.dypatiljhs.com/text.asp?2021/9/3/87/345099
| Introduction|| |
Novel coronavirus disease (COVID-19) first caused an outbreak in Wuhan, China, in December 2019. Ensuing this, lockdown was initiated and only essential services were permitted. There was a concern raised regarding the psychological impact of this quarantine. Previous studies have indicated that people in quarantine reported higher rate of stress, anxiety, depression, and insomnia. Duration of quarantine, frustration, boredom, concern over job security, lack of essential supplies, lack of information, and stigma being the main reasons behind this condition. This pandemic has had a profound impact on the mental health of students in various countries.,,, There was increase in anxiety, depression, and suicidal thoughts., Quantity of sleep increased, but the quality has suffered. Delays in academic activities were positively associated with symptoms of anxiety. It has become crucial that all academic institutes work to protect the mental health of the student population especially from academic stressors. We therefore undertook this study with the objectives of assessing psychological status of undergraduate students with respect to fear, anxiety, and depression related to the pandemic and to evaluate impact on education and various causes affecting it.
| Materials and Methods|| |
In this cross-sectional study, an anonymous web-based survey link was circulated amongst students through WhatsApp, SMS, and email. All participants were requested to forward the link to their classmates/acquaintances pursuing various undergraduate courses across India. Consent of the participant was taken in the first section of the online questionnaire. Information obtained included demographic and academic details. Three validated scales were used to assess fear, anxiety, and depression. Impact on studies was assessed by questions regarding various stressors such as ability to concentrate and effects of online teaching. Institutional Ethics Committee approval was sought prior to start of the study.
A nonprobability snowball sampling strategy was used. The identified study subjects recruited further participants pursuing undergraduate studies from amongst their classmates/peers/acquaintances.
Tools of data collection
The numeric rating scale was used to measure the level of fear in this study., The degree of fear is reflected using 0–10 point with higher score indicating higher fear, as follows: 0 for no fear, 1–3 for mild fear, 4–6 for moderate fear, 7–9 for severe fear, and 10 for extreme fear. The Hamilton Anxiety Rating Scale was used to measure the level of anxiety.,, Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, where <17 indicates mild severity, 18–24 mild to moderate severity and 25–30 moderate to severe. The Zung Self-Rating Depression Scale was used to measure the level of depression.,, Each item is scored on a Likert Scale ranging from 1 to 4. Total score is derived by summing up individual scores and ranges from 20 to 80. Score between 50 and 69 indicate depression, whereas a score of 70 and above indicates severe depression.
All statistical analysis was done by using SPSS software with version 25.0 (IBM SPSS software version 25.0 Chicago USA). All quantitative variables were presented by descriptive statistics and qualitative variables results were shown by frequencies and percentages.
The Chi-square test was used to test the association between the different demographic variables with fear, anxiety, and depression categories. Throughout results 5%, level of significance was used, and all results were shown with 95% of confidence. P < 0.05 consider as statistically significant.
| Results|| |
The demographic characteristics of participants are listed in [Table 1]. Of the 721 respondents, 60% were female. Three-quarter (78.4%) were below the age of 20 years. Almost half the students were in their 2nd year of professional course with 45% pursuing courses in Health Sciences Programs. Half of the students are back in their hometowns, which is in a different city/state from where their college is located. Online classes are being conducted by over three fourth (77.8%) of institutes to which the participants belong. Duration of online teaching by about 50% of the educational institutes was between 2 and 4 hours daily.
Assessment of fear
[Table 2] represents the assessment of fear among the respondents and its correlation with the demographics. The proportion of students with mild, moderate, and severe fear was 17.6%, 43.3%, and 39.1%, respectively. There was significant difference between the levels of fear among male and female students (P < 0.001).
|Table 2: Assessment of fear using Numeric Rating Scale and association with variables (n=721)|
Click here to view
Assessment of anxiety
[Table 3] shows the assessment of anxiety among the respondents. The percentage of students with mild, moderate, and severe anxiety was 74.1%, 23.4%, and 2.5%, respectively. There was significant difference between the levels of anxiety expressed by students in various years of their education (P = 0.001) and between males and females (P < 0.001). There was also a significant difference between the levels of anxiety among students whose parents were health-care professional (and thus involved in treating COVID patients) compared to those students whose parents were not (P = 0.034).
|Table 3: Assessment of anxiety using Hamilton Anxiety Rating Scale and association with variables (n=721)|
Click here to view
Assessment of depression
[Table 4] shows the assessment of depression among the respondents and its relationship with the demographic characteristics. The proportion of students with mild, moderate, and severe depression was 20.7%, 76.4%, and 2.9%, respectively. Level of depression among different years of education was statistically significant (P = 0.001). There was significant difference between the levels of depression between males and females (P = 0.026).
|Table 4: Assessment of depression using Zung Self Rating Depression Scale and association with variables (n=721)|
Click here to view
Impact on academics
Of the total participants, 82.5% responded that the pandemic had affected their academics. [Table 5] displays the various factors that affected the academics of students. Disturbed routine (85.7%) and loss of concentration (71%) were the major causes stated by the students. Only 17.8% students found the ongoing online teaching useful.
|Table 5: Causes that affected participants academics during the pandemic|
Click here to view
| Discussion|| |
The pandemic has forced various countries to impose a lockdown and following social distancing protocols and home quarantine for a few months. Previous scenarios of home confinement have indicated the increased levels of depression. Studies around the world have shown that there is a profound impact of the pandemic on the mental health of the students with increase in levels of anxiety and depression.,,, Our study showed 43.3%, 23.4%, and 76.4% of students experiencing moderate levels of fear, anxiety, and depression, respectively. This result is consistent with findings in China. No significant difference in fear levels among students enrolled in Health Science streams and others was observed. This could be attributed to widespread coverage about the disease on news and social media platforms. Most of the public gain information (correct or incorrect) from Internet and WhatsApp forwards. This is a double-edged sword as distorted facts can increase fear, anxiety, etc., but in the current study seems to have worked to an advantage. Our study indicates a difference in levels of anxiety between males and females, which is quite the opposite from previous study. Majority of the students did not have parents involved in healthcare of COVID patients, which could attribute to less of fear of contracting the disease. More than three fourths of the respondents were found to suffer from moderate depression based on the scale. The reasons for depression can mostly be attributed to change in routine, separation from peers and friends and enforced stay in house. Similar findings are quoted by a study in China. Adjusting in initial days of the pandemic (and nationwide lockdown) led to depression and anxiety. The year of college in which they currently study seems to have a significant association to depression. Similar findings were noted by study done in Spain. Undoubtedly academics have been affected by the pandemic as is evident by 82% of participant responses. Reasons vary but disturbed routine was primary cause stated by most. In addition, not many are finding the online teaching conducted by their respective institutes beneficial. Of course, the altered teaching methodology needs time to get adapted to for both teachers and learners. Stress of examinations (for whenever they will be conducted) on resuming normal college sessions is adding on to the situation. Many are worried about internal assessment affecting their overall academic performance. Majority students opined that their respective educational institutes were as yet not able to design the online teaching to satisfy the students. This along with poor network issues on both sides makes it an overall distressing situation. Rural or remote regions as yet have very few internet connectivity sources, and thus, the student has to perforce miss out on online classes. Students of those courses requiring more of human interaction, laboratory works, etc., are suffering the most. Students from Medical stream are missing out on the clinical case discussion and examination of patients which form the crux of their training. There is probably no satisfactory substitute for the doctor patient live interaction.
Our teaching learning style is not yet letting go of the didactic lectures and very few programs (like the newly introduced CBME curriculum for MBBS students) prepare the student for self-directed learning. It is for such scenarios that we should try to make the student independent of the teacher and more oriented toward the Self directed learning (SDL), flip class method, and Socratic style of learning system. Eye strain due to increased screen time for online lectures, assignments, etc., is the obvious outcome and one more reason for increased stress. Even a generation which spends about 80% of the waking hours online is beginning to feel the vision strain after all the online sessions. Many students were against the colleges conducting internal assessments and examinations in this situation because they felt it was adding to their stress. Furthermore, the uncertainty of the situation and not knowing when colleges would reopen or routine classroom teaching would resume is an additional burden.
Our study has strengths and limitations. Among the strengths, a large sample size allowed us to conduct a thorough analysis and establish solid associations. This being one of the early studies in India regarding the mental health of undergraduate students provides a unique platform to investigate the psychological impact of the pandemic. It provides valuable data to assess the current situation and gain insights about similar conditions in a global aspect. This data was collected after majority of the educational institutes started online teaching hence it highlights the initial problems faced by students who were recently acquainted to online teaching. The impact on academics identifies the major hurdles faced by students and this data will help to plan an online curriculum for the near future and also during future global crisis.
Further investigation needs to be done to assess the triggers which led to increased levels of anxiety and depression. Since this study was initiated when we were a month into lockdown, most of the students were aware about the disease thus the fear levels might be low than what would have been if the study was conducted as soon as the lockdown was imposed.
| Conclusions|| |
Around 43% undergraduate students fear COVID on a moderate level. 23.4% have experienced moderate anxiety and 76.4% are suffering from moderate level of depression due to this pandemic. 82.5% students reported that the pandemic has affected their academics with disturbed routine and lack of concentration being the major causes. Half of the respondents complained of strain on eyes post online classes generating a need for modification in teaching schedule by universities to prevent strain on students. There is a severe impact on the mental health of students during pandemics. Students require emotional and mental support from their family and friends. There should be counselling and opportunities for interaction with experts made available by the Universities. There should be a joint effort by the government and universities to make appropriate facilities available to minimize the impact of pandemics on the mental health of students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Epidemiology Working Group for NCIP Epidemic Response, Chinese Centre for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145-51.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al
. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
Kaparounaki CK, Patsali ME, Mousa DV, Papadopoulou EV, Papadopoulou KK, Fountoulakis KN University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry Res 2020;290:113111.
Odriozola-González P, Planchuelo-Gómez Á, Irurtia MJ, de Luis-García R Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university [published online ahead of print, 2020 May19]. Psychiatry Res. 2020;290:113108. doi:10.1016/j.psychres.2020.113108.
Li HY, Cao H, Leung DY, Mak YW The psychological impacts of a COVID-19 outbreak on college students in China: a longitudinal study. International journal of environmental research and public health. 2020;17:3933.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al
. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020;287:112934.
Becker S, Fuchs X, Schakib-Ekbatan K What does “moderate pain” mean? Subgroups holding different conceptions of rating scales evaluate experimental pain differently. 2020;24:625-38.
Lu W, Wang H, Lin Y, Li L Psychological status of medical work force during the COVID-19 pandemic: A cross sectional study. Psychiatry Res 2020;288:112936.
Zimmerman M, Thompson JS, Diehl JM, Balling C, Kiefer R Is the DSM-5 Anxious Distress Specifier Interview a valid measure of anxiety in patients with generalized anxiety disorder: A comparison to the Hamilton Anxiety Scale. Psychiatry Res 2020;286:112859.
Namat TA, Felea M, Bazyani A, Macovei L, Adoamnei M, Nastasa D, et al
. Psychological evaluation by using the Hamilton depression and anxiety rating scales in coronary artery bypass grafting patients undergoing cardiovascular rehabilitation treatment. Romanian J Cardiol 2020;30:30-4.
Hamilton M The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50-5.
Zung WW, Wonnacott TH Treatment prediction in depression using a self-rating scale. Biol Psychiatry 1970;2:321-9.
Biggs JT, Wylie LT, Ziegler VE Validity of the Zung self-rating depression scale. Br J Psychiatry 1978;132:381-5.
Jokelainen J, Timonen M, Keinänen-Kiukaanniemi S, Härkönen P, Jurvelin H, Suija K Validation of the Zung self-rating depression scale (SDS) in older adults. Scand J Prim Health Care 2019;37:353-7.
Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004;10:1206-12.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]