Changes in College Student Anxiety and Depression From Pre- to During-COVID-19: Perceived Stress, Academic Challenges, Loneliness, and Positive Perceptions

Michelle Haikalis, Hannah Doucette, Matthew K Meisel, Kelli Birch, Nancy P Barnett, Michelle Haikalis, Hannah Doucette, Matthew K Meisel, Kelli Birch, Nancy P Barnett

Abstract

The COVID-19 pandemic is a major stressor that has negatively impacted global mental health. Many U.S. college students faced an abrupt transition to remote learning in March 2020 that significantly disrupted their routines, likely causing changes in mental health. The current study examined changes in anxiety and depressive symptoms among 990 college students, from before COVID-19 had reached U.S. community spread to 5 months into the pandemic. Results indicate overall increases in anxiety and depressive symptoms; this effect was amplified as more COVID-related challenges with academic impact and loneliness were reported. Increases in anxiety and depression were buffered as a function of greater perceived positive changes attributed to COVID-19; the differences in anxiety and depressive symptoms over time were also lessened when greater perceived stress prior to COVID-19 was reported. Findings reveal an unexpected effect involving pre-pandemic stress, and highlight potential targets to promote resilience, which should be examined long-term.

Keywords: COVID-19; anxiety; college; depression; mental health; moderation; resilience.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© 2021 Society for the Study of Emerging Adulthood and SAGE Publishing.

Figures

Figure 1.
Figure 1.
Change in Anxiety from T1 to T2 by Level of Pre-Pandemic Perceived Stress and Gender. Note. This figure represents the predicted change in PHQ-4 anxiety scores from T1 (pre-) to T2 (during-COVID-19) resulting from the analyzed moderation model (see Table 4). Data points represent the estimated change in anxiety at low, average, and high levels of T1 perceived stress (PSS) accounting for academic problems, loneliness, and positive perceptions at their means. At the PSS average, the estimated increase is represented by the constant (.28). Women’s scores reflect greater change from T1 to T2 due to the main effect of gender (.43). Low and high PSS scores represent one standard deviation from the mean. 95% confidence intervals are indicated with error bars.
Figure 2.
Figure 2.
Change in Anxiety from T1 to T2 by Level of Perceived Positive Changes Related to COVID-19 and Gender. Note. This figure represents the predicted change in PHQ-4 anxiety scores from T1 (pre-) to T2 (during-COVID-19) resulting from the analyzed moderation model (see Table 4). Lines representing low, average, and high levels of positive changes related to COVID-19 represent estimated change in anxiety when all other variables in the model are zero (perceived stress, academic problems, and loneliness are at their means). Women’s scores reflect greater change from T1 to T2 due to the main effect of gender (.43). Low and high scores represent one standard deviation from the mean of positive changes attributed to COVID-19. 95% confidence intervals are indicated with error bars.

References

    1. Aiken L., West S., Reno R. (1991). Multiple regression: Testing and interpreting interactions. SAGE Publications.
    1. Alonzi S., Torre A. L., Silverstein M. W. (2020). The psychological impact of preexisting mental and physical health conditions during the COVID-19 pandemic. Psychological Trauma: Theory, Research, Practice, and Policy, 12(1), 236–238. 10.1037/tra0000840
    1. Barnett A. G., van der Pols J. C., Dobson A. J. (2005). Regression to the mean: What it is and how to deal with it. International Journal of Epidemiology, 34(1), 215–220. 10.1093/ije/dyh299
    1. Besser A., Flett G. L., Zeigler-Hill V. (2020). Adaptability to a sudden transition to online learning during the COVID-19 pandemic: Understanding the challenges for students. In Scholarship of Teaching and Learning in Psychology. American Psychological Association, undefined(undefined), undefined. 10.1037/stl0000198
    1. Bonate P. L. (2000). Analysis of pretest-posttest designs (1st ed.). New York: Chapman and Hall/CRC.
    1. Cao W., Fang Z., Hou G., Han M., Xu X., Dong J., Zheng J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 112934. 10.1016/j.psychres.2020.112934
    1. Chen S., Bonanno G. A. (2020). Psychological adjustment during the global outbreak of COVID-19: A resilience perspective. Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1), S51. 10.1037/tra0000685
    1. Clark D. A. (2013). Cognitive restructuring. In The Wiley Handbook of Cognitive Behavioral Therapy (pp. 1–22). John Wiley & Sons, Ltd. 10.1002/9781118528563.wbcbt02
    1. Cohen S., Kamarck T., Mermelstein R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385–396. 10.2307/2136404
    1. Colodro-Conde L., Couvy-Duchesne B., Zhu G., Coventry W. L., Byrne E. M., Gordon S., Wright M. J., Montgomery G. W., Madden P. A. F., Ripke S., Eaves L. J., Heath A. C., Wray N. R., Medland S. E., Martin N. G. (2018). A direct test of the diathesis–stress model for depression. Molecular Psychiatry, 23(7), 1590–1596. 10.1038/mp.2017.130
    1. Cronbach L. J., Furby L. (1970). How we should measure“ change”: Or should we? Psychological Bulletin, 74(1), 68-80. 10.1037/h0029382
    1. DiGiovanni C., Conley J., Chiu D., Zaborski J. (2004). Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecurity and Bioterrorism : Biodefense Strategy, Practice, and Science, 2(4), 265–272. 10.1089/bsp.2004.2.265
    1. Dong E., Du H., Gardner L. (2020). An interactive web-based dashboard to track COVID-19 in real time. The Lancet Infectious Diseases, 20(5), 533–534. 10.1016/S1473-3099(20)30120-1
    1. Durak M., Senol-Durak E. (2010). Psychometric qualities of the UCLA loneliness scale-version 3 as applied in a Turkish culture. Gerontology, 36(10-11), 988-1007. 10.1080/03601271003756628
    1. Ellis W. E., Dumas T. M., Forbes L. M. (2020). Physically isolated but socially connected: Psychological adjustment and stress among adolescents during the initial COVID-19 crisis. Canadian Journal of Behavioural Science, 52(3), 177–187. 10.1037/cbs0000215
    1. Elmer T., Mepham K., Stadtfeld C. (2020). Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS One, 15(7), e0236337. 10.31234/
    1. Faravelli C., Lo Sauro C., Lorenzo L., Francesco P., Lazzeretti L., Godini L., Benni L., Fioravanti G., Talamba G. A., Castellini G., Ricca V. (2012). The role of life events and hpa axis in anxiety disorders: a review. Current Pharmaceutical Design, 18(35), 5663–5674. 10.2174/138161212803530907
    1. Ghebreyesus T. A. (2020). Addressing mental health needs: an integral part of COVID-19 response. World psychiatry, 19(Issue 2), 129–130. 10.1002/wps.20768
    1. Gillis A., Krull L. M. (2020). COVID-19 remote learning transition in spring 2020: Class structures, student perceptions, and inequality in college courses. Teaching Sociology, 48(4), 283–299. 10.1177/0092055X20954263
    1. Gruber J., Prinstein M., Abramowitz J., Albano A. M., Aldao A., Borelli J., Clark L. A., Davila J., Forbes E., Gee D., Hall G. N., Hallion L., Hinshaw S., Hofmann S., Hollon S., Joormann J., Kazdin A., Klein D., Levenson R., Weinstock L. M. (2020). Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. American Psychologist, 76(3), 409–426. 10.31234/
    1. Hamza C. A., Ewing L., Heath N. L., Goldstein A. L. (2021). When social isolation is nothing new: A longitudinal study on psychological distress during COVID-19 among university students with and without preexisting mental health concerns. Canadian Psychology/Psychologie Canadienne, 62(1), 20–30. 10.1037/cap0000255
    1. Hartshorne T. S. (1993). Psychometric properties and confirmatory factor analysis of the UCLA Loneliness Scale. Journal of Personality Assessment, 61(1), 182-195. 10.1207/s15327752jpa6101_14
    1. Hoffart A., Johnson S. U., Ebrahimi O. V. (2020). Loneliness and social distancing during the COVID-19 pandemic: Risk factors and associations with psychopathology. Frontiers in Psychiatry, 11, 589127. 10.3389/fpsyt.2020.589127
    1. Ho A. D., Yu C. C. (2015). Descriptive statistics for modern test score distributions: Skewness, kurtosis, discreteness, and ceiling effects. Educational and Psychological Measurement, 75(3), 365–388. 10.1177/0013164414548576
    1. Judd C. M., Kenny D. A., McClelland G. H. (2001). Estimating and testing mediation and moderation in within-subject designs. Psychological Methods, 6(2), 115–134. 10.1037/1082-989X.6.2.115
    1. Khubchandani J., Brey R., Kotecki J., Kleinfelder J., Anderson J. (2016). The psychometric properties of PHQ-4 depression and anxiety screening scale among college students. Archives of Psychiatric Nursing, 30(4), 457-462. 10.1016/j.apnu.2016.01.014
    1. Kleiman E. M., Chiara A. M., Liu R. T., Jager-Hyman S. G., Choi J. Y., Alloy L. B. (2017). Optimism and well-being: a prospective multi-method and multi-dimensional examination of optimism as a resilience factor following the occurrence of stressful life events. Cognition and Emotion, 31(2), 269–283. 10.1080/02699931.2015.1108284
    1. Kroenke K., Spitzer R. L., Williams J. B. W., Löwe B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics, 50(6), 613–621. 10.1016/s0033-3182(09)70864-3
    1. Maner J. K., Schmidt N. B. (2006). The role of risk avoidance in anxiety. Behavior Therapy, 37(2), 181–189. 10.1016/j.beth.2005.11.003
    1. Montoya A. K. (2019). Moderation analysis in two-instance repeated measures designs: Probing methods and multiple moderator models. Behavior Research Methods, 51(1), 61–82. 10.3758/s13428-018-1088-6
    1. Montoya A. K., Hayes A. F. (2017). Two-condition within-participant statistical mediation analysis: A path-analytic framework. Psychological Methods, 22(1), 6–27. 10.1037/met0000086
    1. Novacek D. M., Hampton-Anderson J. N., Ebor M. T., Loeb T. B., Wyatt G. E. (2020). Mental health ramifications of the COVID-19 pandemic for black Americans: Clinical and research recommendations. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 449. 10.1037/tra0000796
    1. Palgi Y., Shrira A., Ring L., Bodner E., Avidor S., Bergman Y., Cohen-Fridel S., Keisari S., Hoffman Y. (2020). The loneliness pandemic: Loneliness and other concomitants of depression, anxiety and their comorbidity during the COVID-19 outbreak. Journal of Affective Disorders, 275, 109–111). 10.1016/j.jad.2020.06.036
    1. Pearlin L. I. (2010). The life course and the stress process: Some conceptual comparisons. Journals of Gerontology - Series B Psychological Sciences and Social Sciences, 65 B(2), 207–215. 10.1093/geronb/gbp106
    1. Pierce M., Hope H., Ford T., Hatch S., Hotopf M., John A., Kontopantelis E., Webb R., Wessely S., McManus S., Abel K. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. 10.1016/S2215-0366(20)30308-4
    1. Prowse R., Sherratt F., Abizaid A., Gabrys R. L., Hellmans K. G., Patterson Z. R., McQuaid R. J. (2021). Coping With the COVID-19 Pandemic: Examining Gender Differences in Stress and Mental Health Among University Students. Frontiers in Psychiatry, 12. 10.3389/fpsyt.2021.650759
    1. Qiu J., Shen B., Zhao M., Wang Z., Xie B., Xu Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General PsychiatryBMJ Publishing Group, 33(Issue 2), 100213. 10.1136/gpsych-2020-100213
    1. Rand K., Kurth M., Fleming C. H., Linkov I. (2020). A resilience matrix approach for measuring and mitigating disaster-induced population displacement. International Journal of Disaster Risk Reduction, 42, 101310. 10.1016/j.ijdrr.2019.101310
    1. Rogosa D. (1995). Myths and methods: “Myths about longitudinal research” plus supplemental questions. In The analysis of change. Lawrence Erlbaum Associates, Publishers.
    1. Russell D., Peplau L. A., Cutrona C. E. (1980). The revised UCLA loneliness scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39(3), 472–480. 10.1037/0022-3514.39.3.472
    1. Selden T. M., Berdahl T. A. (2020). COVID-19 And Racial/Ethnic Disparities In Health Risk, Employment, And Household Composition: Study examines potential explanations for racial-ethnic disparities in COVID-19 hospitalizations and mortality. Health Affairs, 39(9), 1624-1632. 10.1377/hlthaff.2020.00897
    1. Tavakol M., Dennick R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53–55. 10.5116/ijme.4dfb.8dfd
    1. Thomas D. R., Zumbo B. D. (2012). Difference scores from the point of view of reliability and repeated-measures ANOVA: In defense of difference scores for data analysis. Educational and Psychological Peasurement, 72(1), 37-43. 10.1177/0013164411409929
    1. Twisk J., Proper K. (2004). Evaluation of the results of a randomized controlled trial: how to define changes between baseline and follow-up. Journal of Clinical Epidemiology, 57(3), 223-228. 10.1016/j.jclinepi.2003.07.009
    1. van der Velden P. G., Contino C., Das M., van Loon P., Bosmans M. W. G. (2020). Anxiety and depression symptoms, and lack of emotional support among the general population before and during the COVID-19 pandemic. A prospective national study on prevalence and risk factors. Journal of Affective Disorders, 277, 540–548. 10.1016/j.jad.2020.08.026
    1. Wang C., Pan R., Wan X., Tan Y., Xu L., Ho C. S., Ho R. C. (2020. a). Immediate Psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. 10.3390/ijerph17051729
    1. Wang X., Hegde S., Son C., Keller B., Smith A., Sasangohar F. (2020. b). Investigating mental health of US college students during the COVID-19 pandemic: Cross-sectional survey study. Journal of Medical Internet Research, 22(9), e22817. 10.2196/22817
    1. Ye Z., Yang X., Zeng C., Wang Y., Shen Z., Li X., Lin D. (2020). Resilience, social support, and coping as mediators between COVID‐19‐related stressful experiences and acute stress disorder among college students in China. Applied psychology: Health and well-being. aphw.12211. Advance online publication. 10.1111/aphw.12211
    1. Zacher H., Rudolph C. W. (2020). Individual differences and changes in subjective wellbeing during the early stages of the COVID-19 pandemic. American Psychologist, 76(1), 50–62. 10.1037/amp0000702

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