Depression, Anxiety, and Perceived Stress During a Pandemic: An Understanding of the Psychological Impact of COVID-19 on a University Community
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Abstract
COVID-19 is a viral infectious disease that first occurred in Wuhan, China in December 2019 and by March 2020, it was declared a pandemic by the World Health Organization. Mental health – especially as it relates to physical distancing, loneliness, and stress – is a major public health concern as the COVID-19 pandemic continues. The social, economic, and environmental effects have been associated with emotional distress, anxiety, loneliness, boredom, depression, irritability, frustration, insomnia, blaming, anger, panic attacks, delirium, general fear, fear of dying or falling sick, helplessness, confusion, and stigma. Despite the increased attention on mental health and the psychological impact of COVID-19 on the general population, and even student populations, studies have been primarily conducted outside the United States (U.S.) and focused on the immediate aftermath or earliest stages of the pandemic. Few studies have focused on university communities and even fewer included faculty and staff in the study population. Furthermore, many evaluated the immediate aftermath or earliest stages of the pandemic rather than possible effects months or a full year later. Given this, the purpose of this three-manuscript dissertation was to understand "what impact has COVID-19 had on the psychological wellbeing of faculty, staff, and students at a public American research university?" and includes three primary aims: 1) to explore how sociodemographic factors are related to the psychological impact of COVID-19 on a collegiate community; 2) to evaluate the association between physical distancing and psychological impact, with past community trauma and social support as effect modifiers; and 3) to evaluate the association between perceived stress and depression and anxiety symptoms with resilient coping and social support as mediators of this relationship. Two frameworks guided this study – the Social and Cultural Determinants of Mental Disorders Framework by Lund, et al. and the Stress Buffering Model by Cohen & Willis. This quantitative study employed primary data collection. A cross-sectional study of a university population used a web-based, online questionnaire to collect information on the psychological impact of COVID-19 as evidenced by anxiety symptoms (using the Generalized Anxiety Disorder 7-item Scale), depression symptoms (using the Patient Health Questionnaire 9-item Scale), and perceived stress (using the Perceived Stress Scale). The questionnaire also used the DeJong Geirveld Loneliness Scale to assess loneliness, the Multidimensional Scale of Perceived Social Support to assess perceived social support, and the Brief Resilient Coping Scale (BRCS) to measure resilient coping. An email was sent via an anonymous link to every member of the university – all faculty, students, and staff – who were working or enrolled at the university prior to the start of the Spring 2020 semester (i.e. January 8, 2020). Data were collected over ten weeks between December 2020 and February 2021. Summary statistics of the sociodemographic characteristics of participants and outcomes were calculated. Both ordinal and binary logistic regression was used to obtain odds ratios and 95% confidence intervals to provide unadjusted measures of the associations between each of the exposures and outcomes, depending on the study. Multivariate ordinal and logistic regression models, controlling for confounders, were created by including all the potential predictors in each model and then using a backwards elimination procedure to retain only predictor variables with p <0.20. In chapter three, stratified analyses were used to evaluate whether past community trauma or perceived social support modified the physical distancing and psychological wellbeing association. In chapter four, to understand more accurately whether resilient coping or social support directly affected and partially mediated the relationships between exposure and outcomes, mediation analyses were conducted. All analytical procedures were conducted using SAS statistical software package, version 9.4.Results consistently revealed COVID-19 has had substantial psychological impacts on the mental health of university faculty, staff, and students including increased depression, anxiety, perceived stress, and loneliness. There seems to be evidence of groups that experience higher increased odds of poor mental health outcomes including but not limited to cisgender women, those who perceive themselves to be most lonely, and those who did not engage in physical distancing. Perception of the degree of coping was one of the two the strongest predictors of severe anxiety symptoms (OR: 6.82; 95% CI: 4.16, 11.19), depression symptoms (OR: 6.41, 95% CI: 3.96, 10.36), and high perceived stress (OR: 3.11; 95% CI: 1.98, 4.89). The second study also revealed that those who did not engage in physical distancing had increased odds of severe depression symptoms (OR: 1.33; 95% CI: 0.88, 2.00) and severe anxiety symptoms (OR: 1.37; 95% CI: 0.89, 2.09); but not higher perceived stress (OR: 1.04; 95% CI: 0.66, 1.64). This relationship was modified by past exposure to community trauma. While those who reported higher perceived stress had over three times the odds of severe anxiety (OR: 3.69. 95% CI: 2.65, 5.14) and over 11 times the odds of severe depression symptoms (OR: 11.10; 95% CI: 7.39, 16.67), the relationship was not mediated by past exposure community trauma or resilient coping. To the best our knowledge, this dissertation was the first to focus on depression, anxiety, and perceived stress among an entire university community in the Southeast U.S. within the context of the ongoing COVID-19 pandemic. At this time, it is also the first in the U.S. to investigate the potential mediating effect of resilient coping using the BRCS on this population. There are a number of public health implications given the results of this dissertation. For example, this pandemic’s impact on mental health requires an understanding to have better dissemination of tools to help individuals to cope and to know when, how, and where they need to seek additional help. Moreover, future studies need to explore why particular groups are more vulnerable to experiencing poor mental health outcomes such as anxiety, depression, and perceived stress. Additional studies are also needed to understand how various mediating factors such as perceived social support and resilient coping affect mental health outcomes given that these factors are potentially modifiable. Collectively, this study presents an understanding of the significant psychological impact that the COVID-19 pandemic has had on this university community. It suggests this population requires collaboration between the community and the university administration to provide greater attention and support in the form of high quality and timely services and preventive measures to minimize the likelihood of poor mental health outcomes, particularly in those higher risk groups, now and in the future.