To our knowledge, this is the first Brazilian study to provide information on anxiety and depression levels of university students during the period of social isolation. This study aimed to assess depression and anxiety among university students and their level of satisfaction with online learning during the period of social isolation caused by the COVID-19 pandemic. Participants had moderate levels of anxiety, with no significant gender differences, and mild levels of depressive symptoms with significant gender differences. Also, younger students were more anxious than older students. Additionally, female students with fewer social contacts had higher levels of depression. Our results align with a US national survey [18, 19] among faculty and students in June 2020, which highlighted gender disparities in online learning during the pandemic, where female faculty and students reported more challenges around technology issues and adaptation distance learning compared to their male peers. Another study  showed that nearly half of college students had levels of anxiety ranging from mild to severe, with women reporting higher anxiety scores. Also, Saddick et al. , in a large sample of 7,228 university students from Poland, demonstrated a significant increase in levels of depression as the pandemic progressed, with female students scoring significantly higher than male students in depression, anxiety and of stress. Similar studies conducted longitudinally with university students found a significant increase in depression and anxiety compared to previous levels of COVID-19 .
The COVID-19 pandemic has disrupted the lives of everyone, including university students, especially with the preventive measures aimed at reducing the transmission of the virus, which has led to converting all face-to-face teaching and learning into e- learning. The COVID-19 pandemic and the establishment of online learning may have influenced the mental conditions of students. A study aimed to determine the association of factors with mental health status (depression, anxiety and stress) among college students in Malaysia, private and public universities, recruited via university emails and social media . The survey was administered through the online platform REDCap, from April to June 2020, during the movement control order period in the country. The questionnaire collected data on socio-demographic characteristics, academic information, implementation of e-learning, perception of e-learning, and COVID-19; as well as DASS 21 to screen for depression, anxiety and stress. Levels of stress, anxiety and depression were 56.5% (95% CI: 50.7%, 62.1%), 51.3% (95% CI: 45.6%, 57 .0%) and 29.4% (95% CI: 24.3%, 34.8%). ) respectively. Most participants had a good perception of e-learning but a negative perception of COVID-19.
The present study shows that social isolation contributed to depressive symptoms in university students. The impact of the period of social isolation on university students can be heavy due to its perceived effect on their activities of daily living and studies . Fawaz and Samaha (2020) point out that university students are particularly susceptible to developing stress and depression with an expected increase during the COVID-19 pandemic related to their psychological challenges, learning conditions, uncertainty about in the future, fear of infection, news about lack of personal protective equipment, quarantine-induced boredom, frustrations, lack of freedom and fears caused by rumors and misleading information in the media [10, 20, 21]. Additionally, social isolation can also lead to sedentary behavior, which is detrimental to the prevention of physical, cognitive, psychological and social health problems. . Thus, low self-esteem, feelings of worthlessness and loss of autonomy may also be linked to the presence of levels of anxiety and depressive symptoms found in our study. Further studies should investigate psychological distress to assess its impact on levels of depression and anxiety in this population.
Our findings align with a study that explored the association between the effects of home-based learning during the pandemic and the risks of depression, anxiety, and suicidality among junior and senior high school students. An online survey using the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) was conducted between April 12-30, 2020, with a total of 39,751 students. Multivariate logistic regression analysis was used to analyze risk factors for depression, anxiety, and associated suicidality during the pandemic. The prevalence of depression, anxiety symptoms and suicidal tendencies was 16.3% (95% CI: 16.0, 16.7), 10.3% (95% CI: 10.0, 10.6) and 20.3% (95% CI: 19.9, 20.7), respectively. . Female and junior high school participants with poor overall sleep quality, poor academic performance, and very worried about getting infected during COVID-19 were strongly associated with risk for depression, anxiety symptoms, and thoughts suicidal . Another study, conducted via an online survey of 5,100 medical students from Wannan Medical College in China, aimed to assess the mental health status of medical students engaged in home-based online learning during the pandemic, in exploring potential risk factors for mental health. The Depression, Anxiety, and Stress Scale (DASS-21) was used to measure self-reported symptoms of depression, anxiety, and stress in 4115 medical students. Nearly a third of medical students have survived with varying degrees of depression, anxiety and symptoms of stress while online learning during the COVID-19 pandemic . These results demonstrated that the mental state of university students was greatly affected during the COVID-19 pandemic. .
We also studied the level of satisfaction with online learning and its impact on students’ lives. We found that students who felt impacted by their financial situation had an increase in anxiety as demonstrated on the HADS scale, corroborating studies that show the mental and emotional impacts on students’ daily lives. [20, 21]. Additionally, we found that most students viewed online learning as regular, with significant differences between the level of anxiety and depressive symptoms and the level of satisfaction with online education. Most students reported emotional impact related to the period of social isolation and online learning, with significant differences in depressive symptoms, followed by impact on learning, financial impact, l social impact and technological impact. We also found that younger students were more dissatisfied with online learning than older students. Student intentions and attitudes toward online education can play a significant role in retention rates and end results of online learning. Studies have shown that student interactions have a strong relationship with emotional and social engagement and a sense of community, which is important for effectively promoting learning engagement. . We can assume that these students have to deal with unexpected and continuous changes such as the lack of interpersonal contacts and daily academic activities and the need to adapt to their routine and household resources. However, in addition to these personal aspects, there is a need to discuss the effectiveness of e-learning and its potential barriers in developing contexts. Students from developing countries presented lower scores in online learning and were more likely to drop out of online courses than their colleagues from developed countries .
One of the main challenges of the Brazilian education system is the inequality of educational resources, including the use of computers, Internet access and other technological resources. . A survey conducted by a group of institutions in Brazil revealed that Internet access (23%) was the main problem in distance learning, followed by content difficulties (20%), lack of devices ( 15%) and lack of interest (15%). ) [16, 22]. Therefore, our results can be related both to students’ intentions and attitudes and to the quality of educational resources.
Strengths and limitations
Our findings may aid in the development of actions to identify the need for medical and psychological interventions for university students during periods of online learning. For example, universities should incorporate epidemiological practices and involve health professionals as supervisors and advisors throughout the programs [24, 25]. However, our results should be interpreted with caution as this study has several limitations. First, the use of a small convenience sample and its descriptiveness through an online survey with few variables may not allow generalizability of the results. Students who had previously been diagnosed with depression or anxiety were excluded from the study through an interview before testing began. Anxiety and depressive symptoms may be due to many factors other than COVID-19, which may not have been taken into account by this method. Second, the nature of the self-reported data in the survey can lead to response bias. This study primarily used self-report questionnaires to measure psychiatric symptoms and did not make a clinical diagnosis. The gold standard for establishing a psychiatric diagnosis involves a structured clinical interview and functional neuroimaging. Moreover, the statistical analysis did not provide evidence of a causal nature. However, our hypotheses were well targeted based on the psychological evidence available in the previous literature. [26,27,28,29]. Finally, we did not adjust for multiple comparisons, which may bias P-values as measures of importance. However, our findings are clinically significant as they may provide suggestions to policy makers regarding improving student performance and preventing mental health problems.