Discussion:
The goal of this study was to evaluate the psychological conditions of university students during the COVID-19 pandemic and explore factors influencing their psychological problems. This study indicated that 41.1% of university students at Umm AlQura University in Saudi Arabia were afflicted with symptoms of depression, 26.9% with anxiety, and 22.4% with stress.
Previous studies have suggested that the COVID-19 pandemic had profound negative psychological impacts on the general population as well as students(16). A study from Jordan assessed the prevalence of depression using the Patient Health Questionnaire and anxiety using Generalized Anxiety Disorder-7 among 1165 university students and showed that more than 60% of the surveyed students had moderate to severe depression and more than 45% had moderate to severe anxiety (6). Yet, it is difficult to compare their results with those of the current study because the authors used a convenience sampling approach that favors the inclusion of students with psychological problems in addition to using a different tool to assess depression and anxiety. In Spain, a total of 2530 members of the University of Valladolid were surveyed online for their psychological conditions using the DASS-21. The results showed that the prevalence of any degree of depression, anxiety, and stress was as follows: 48.1%, 35.2%, and 40.3% while the prevalence of the moderate to severe forms was as follows: 34.2%, 21.3%, and 28.1%, respectively(13). The higher rates of all psychological conditions compared with ours, despite using the same study design and evaluation methods, could be explained by the fact that Spain was among the most affected countries worldwide in terms of the COVID-19 cases, deaths, and economic losses (2, 17).
It could be predicted that the quarantine measures and the state of anticipation about the academic progress during the COVID-19 pandemic may have harmed the students’ mental and psychological health. A longitudinal study on 555 university students in China revealed increases in symptoms of anxiety and depression after two weeks of quarantine(10). Besides, the new learning environment that is based completely on online education may be addressed differently among students with various psychological reflections(7). Moreover, the students’ psychological affection may have been related to stressors associated with social and physical distancing measures, infection fear, and boredom (18). It is not surprising that anxiety disorders are more likely to occur and worsen in the absence of interpersonal communication(19). A study conducted in Saudi Arabia on medical students claimed that being detached from friends was a major cause of anxiety (8). Our findings and similar studies can recommend the importance of providing urgent psychological services to university students to mitigate the psychological impacts of the COVID-19 pandemic.
We also highlighted the role played by other stressors in the students’ psychological instability during the current COVID-19 pandemic. For example, the current study illustrated that having a relative or a friend infected with or died from the COVID-19 was associated with an increased level of depression and anxiety and this was consistent with previous literature(11, 20). Watching COVID-19 news for long times per day was associated with depression, anxiety, and stress. As a consequence of the current pandemic, many people turn to social media outlets to connect with others and to express their feelings about the pandemic (21). Although media is considered a good source of information about safety precautions and prevention strategies, excessive description of COVID-19 news can create a sense of panic among vulnerable individuals. Social media and uncurious netizens may also be a source of fake scary information (20, 22). This finding should raise the attention of mental health professionals to advise the public for a wise watching of the news and to cautiously use social media and telecommunication websites.
Moreover, the current study showed that students who reported lack of sleep had more stress and anxiety. Sleep disturbances are a stand-alone risk factor for psychological consequences. Appropriate treatment of sleep disturbances is always vital and reduces symptoms of psychiatric disorders (23). Recognizing and treating such disorders are particularly important during stressful times (24).
Furthermore, students who did not receive emotional support from their families, societies, and universitywere more likely to experience psychological problems. The current COVID-19 pandemic is considered an inexperienced crisis that affected the mental health of the exposed people and requires psychological support. A study on medical students from China showed that social support correlated negatively with their level of anxiety(11). One study discussed the need for providing mental healthcare services to students to alleviate their psychological disturbances (25). We should, therefore, there is a need to pay greater attention to the mental health of university students and actively provide them with psychological support and counseling.
This study carried many strengths such as investigating, for the first time, the psychological conditions among a large cohort of university students in Saudi Arabia and using a validated tool to measure their psychological problems. However, the study has some limitations that should be addressed. First, the cross-sectional design of this study cannot imply causality, and the baseline psychological conditions before the COVID-19 pandemic could not be assessed. Therefore, we cannot conclude that the COVID-19 pandemic was the only reason to provoke such psychological disturbances. Second, investigating one university in Saudi Arabia maybe not representative of the rest of the universities in the country. Third, the online approach of data collection could carry a potential possibility of non-response bias (26). To minimize the risk of this bias, we sent the questionnaire through all the possible means of communication with students of Umm AlQura University. We made the online questionnaire available for participation for a week and extended its availability for another week while sending reminders to students and encouraging them to share the questionnaire by sending it to their colleagues.
In conclusion, this study showed that students at Umm AlQura University suffered psychological problems during the COVID-19 pandemic. These problems were associated with related infection or death of a family member or relative, excessive following of news, lack of emotional support from the family, society, and the university. Our findings can be used to articulate psychological interventions to improve mental health and psychological resilience during the COVID-19 pandemic. It is warranted for universities to have a role in helping students respond to the pandemic in a healthier psychological performance.
Conflict of interest : the authors declare no competing interests.
Author Contributions: ZM and AA drafted the manuscript and substantially revised it, under supervision of AE. All authors have read and agreed to the published version of the manuscript.
Acknowledgment: The authors acknowledge the participated students
Funding: no funding source