THIS IS A PEER-REVIEWED, ACCEPTED AUTHOR MANUSCRIPT OF THE FOLLOWING RESEARCH

ARTICLE: Wood, C. I., Yu, Z., Sealy, D-A., Moss, I., Zugbuo-Wenzler, E., McFadden, C., Landi, D., &
Brace, A. M. (2022). Mental health impacts of the COVID-19 pandemic on college students. Journal of
American College Health. https://doi.org/10.1080/07448481.2022.2040515

Mental Health Impacts of the COVID-19 Pandemic on College Students

1
Mental health impacts of the COVID-19 pandemic on college students

Abstract

The COVID-19 pandemic is having profound effects on college students. Students with mental

health conditions are more vulnerable to the impact of stress, as it can exacerbate mental health

symptoms. In order to study the impact of the COVID-19 pandemic on college students’ mental

health, 773 students completed the survey and 489 were included in the final analysis.

Participants were mostly female, undergraduate, and aged 18-25. Approximately 81.6 % self-

reported at least one negative mental health symptom. Students reported increased feelings of

hopelessness (+7.8%), loneliness (+6.7%), sadness (+8.8%), depression (+2.6%), anxiety

(+5.2%), and anger (+14.6%) during COVID-19 than before. LGBTQ students and Black

students had significantly more mental health symptoms during the COVID-19 pandemic when

compared with straight and White students. Results of this study highlight the negative impact of

the COVID-19 pandemic and resultant changes on college students’ mental health.

Keywords: COVID-19, mental health, health, college students, stress

Mental health impacts of the COVID-19 pandemic on college students

Mental Health Impacts of the COVID-19 Pandemic on College Students

COVID-19, a disease caused by the novel SARS-COV-2 virus, has spread so rapidly and

widely it has become a worldwide pandemic.1,2 The combination of the potentially dire

consequences that can result from catching and transmitting the disease, along with the lack of

information and treatment for the disease, has led to a forceful change in how humans live. The

new lifestyle consists of social distancing, frequent handwashing, wearing face masks, and self-

isolation. Some researchers suggest that the drastic change in lifestyle during the pandemic may

have an adverse effect on mental health. More specifically, the psychological distress

accompanying the lifestyle change may lead to the development or exacerbation of mental

illnesses such as depression and anxiety.3 While major health organizations, such as the World

Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) advise

implementing measures aimed at benefiting the public’s physiological health, it is just as

important to consider the psychological impact that has resulted from the COVID-19

pandemic.3,4

College students are uniquely vulnerable to experience heightened levels of stress that

may arise from factors such as academic pressure, developing and maintaining relationships,

establishing autonomy, lifestyle changes, and financial challenges. The accumulation of these

stressors can make college students particularly vulnerable to developing mental health

disorders.5 Evidence also indicates that the median age of onset for some mental health disorders

is during young adulthood, contributing to this finding may be the unique levels of stress that

college students experience.6 The profound levels of stress and mental health disorders that

college students undergo has led researchers to focus on college students’ reactivity to stress.

However, it is critical to further research efforts evaluating college students’ reaction to the
Mental health impacts of the COVID-19 pandemic on college students

COVID-19 pandemic, as the exacerbated levels of stress can severely impact college students’

mental health because of their susceptibility to mental illness.

Stress and Mental Health of College Students

Stress is an inevitable and integral part of human existence. From an evolutionary

perspective, stress plays a fundamental role in human survival. Humans would rely on their

physiological response to a stressor or threat in order to initiate the appropriate behavioral

responses that would promote survival. More recently, stress has transformed from a biological

response to now being recognized as a state of mental or emotional strain that can have negative

repercussions on mental health, such as the onset of schizophrenia, anxiety disorders, and

depression.7

Under normal circumstances, college students report experiencing a high level of

perceived stress.8 A large part of the stress college students experience, particularly younger

students, is credited to the abrupt change in their lifestyle from high school to college. In most

cases, students are placed in a position where they need to live on their own, develop a routine,

build social connections, perform well academically, along with being able to manage or provide

for themselves financially. The abrupt change in responsibility can adversely affect stress levels

and overall well-being.9 This increase in perceived stress can have a host of deleterious effects

on students including greater depression and anxiety symptoms, lower academic performance,

lower levels of physical activity, worse overall health, impulse control concerns, lower levels of

self-esteem, relationships with friends, and higher internet use.10,11

The current literature suggests that stress can lead to the development of a new mental

health condition, or exacerbate symptoms of an existing mental health condition, as a result of

engagement in maladaptive behaviors. The maladaptive behaviors associated with stress include
Mental health impacts of the COVID-19 pandemic on college students

lower levels of physical activity, poor sleep quality, unhealthy eating habits, poor self-esteem,

and inability to maintain social relationships.12,13 Therefore, it is important to continue evaluating

college students’ mental health and well-being during the COVID-19 pandemic as they may be

experiencing an unusually high level of stress.

Health Behaviors on Mental Health

The relationship between stress and mental health is due, in part, to the negative health

behaviors associated with stress that can intensify experiences of psychological distress, which

can play a role in the onset of a mental illness.14 Previous research evaluating the relationship

between stress and health behaviors suggests that higher levels of stress are associated with

lower levels of physical activity, unhealthy eating habits, and poor sleep patterns.12,13 The

adverse impact stress has on maintaining a healthy lifestyle severely impacts well-being and

increases the likelihood of developing a mental illness.3

Health behaviors such as physical activity have been shown to improve symptoms of

mental health conditions. Research has supported the objective that engaging in physical activity

improves mental health, specifically, alleviating depressive symptoms and anxiety.15 In their

meta-analysis of the impact of physical activity on stress, Stults-Kolehmainen and Sinha12 found

that psychological stress predicts less physical activity and greater sedentary behavior.

Another health behavior shown to impact stress and mental health is healthy eating

behavior. Unhealthy eating deprives the body of important nutrients such as, zinc, magnesium,

and long chain omega-3 fatty acids. Lower levels of these critical nutrients are associated with

increased rates of depression and anxiety disorders.16 Research has also shown a strong

relationship between stress and unhealthy eating habits. Stress increases the likelihood of having

a high-caloric diet along with eating greater fatty foods (i.e., sugar).17
Mental health impacts of the COVID-19 pandemic on college students

Finally, sleep is another health behavior show to impact stress and mental health. Stress

causes an increase in heart rate, sympathetic nervous system activity, and releases the hormone,

cortisol.13 Cortisol inhibits the production of melatonin, which directly affects an individual’s

sleep habits. The impaired sleep habits then affect emotion regulation, quality of life, and

psychosocial health,18 all of which contribute to an increased risk of developing depressive

symptoms, anxiety, and mood disorders.13

These findings are important to consider when further evaluating the impact of the

COVID-19 pandemic, a situation that generated a variety of different stressors, on college

students’ mental health. Prior research suggests that increased levels of stress significantly

decrease levels of physical activity, promote poor eating habits, and alter sleep routines. We can

infer from these previous findings that college students, a group already susceptible to high

levels of stress, are at risk of having mental health disturbances as a result of not maintaining

these health behaviors.

COVID-19 and College Students

College students abruptly transitioned from on-campus learning to remote learning

during the spring of 2020. Remote learning consisted of either synchronous learning, live class

conducted virtually, or asynchronous learning, pre-recorded lectures viewed independently.

Along with adjusting with the new learning style, students still needed to meet the same

academic standards and study habits.

Another complication that occurred as a result of the COVID-19 pandemic was the

transition from on-campus living to off-campus living. Unexpectedly, students were informed

that there will no longer be on-campus activities and were asked to leave their on-campus

housing. This created a lot of obstacles for students that were adjusted to living independently
Mental health impacts of the COVID-19 pandemic on college students

and are now forced to give up their autonomy; one of the main benefits of living on a college

campus. College students then had to readjust to a new environment. In the new environment

students had to quickly adapt to the new situation in order to maintain their academic standards.

Along with losing their housing, college students all lost access to their friends and peers,

that provided a unique source of emotional support. The COVID-19 pandemic generated new

restrictions in order to follow public health safety protocals. The protocols primarily consisted of

being quarantined and practicing social distancing. Confined to living at home and not being able

to see peers and friends, took away one of the main sources of coping with stress. As a result,

college students are extremely vulnerable to psychological distress by not being able to

effectively cope with the unusually intense levels of stress.

Methods and Measures

Participants

Students enrolled in a college of health professions received an invitation to complete a

survey about their experiences during the early part of the COVID-19 pandemic (approximately

March 2020-June 2020). Of the 773 students who completed the electronic survey, 489

participants were included in the final analysis. Students not enrolled in the spring semester 2020

and students who completed less than 70% of survey were excluded in the final analysis. The

study sample self-identified as mostly female (88.3%), full-time students (88.0%), undergraduate

(78.4%), and between the ages of 18-25 years (88.9%) with a mean age of 20.3. All 489

participants reported their races, 61.1% identified themselves as White, 22.3% identified

themselves as Black, and 16.6% identified themselves as other races. When asked about sexual

orientation, 422 (86.3%) participants identified as straight, 63 (12.9%) identified as LGBTQ, and

4 participants did not disclose sexual orientation.

Mental health impacts of the COVID-19 pandemic on college students

Measures

Students’ mental health symptoms during COVID-19 were measured by a series of eight

questions asking whether they have felt 1) things were hopeless, 2) overwhelmed by all they had

to do, 3) exhausted (not from physical activity), 4) very lonely, 5) very sad, 6) so depressed it

was difficult to function, 7) overwhelming anxiety, and 8) overwhelming anger during the past

30 days. The number of mental health issues each student experienced during the past 30 days

were calculated to measure the overall mental health problem students had during COVID-19. A

recall period of 30 days was used to be safely contained within the outbreak of COVID-19 in the

United States, given all surveys were administered in June 2020. Susceptibility to COVID-19

was measured by the question “How likely do you think it is that you will develop COVID-19?”

Statistical Analysis

The study sample was described by frequencies and percentages of categorical sample

characteristics including age, gender, enrollment statuses, race, and fraternity/sorority

involvement. Means and standard deviations of self-rated subjectivity to COVID-19 and overall

stress level were calculated by sample characteristics. Frequencies and standard deviations of

eight mental health issues were calculated by sample characteristics. Multiple regression was

used to identify whether and how each sample characteristic associated with the overall mental

health problem of college students. Statistical analysis was conducted using STATA MP 14.

Percentages of students experienced each of the eight mental health issues were also calculated

among all study participants and compared with percentages calculated from a sample of

National College Health Assessment surveyed before the outbreak of COVID-19 during 2016-

2018. The same comparison was made among Black students and LGBTQ students, which were

identified as high-risk groups in the regression model.

Mental health impacts of the COVID-19 pandemic on college students

Results

Table 1 summarizes characteristics of the study sample. Students between 26-30 years

old reported the highest perceived susceptibility to COVID-19. Female students had higher mean

perceived susceptibility score than male students (1.95 vs 1.82). LBGTQ and

graduate/professional students were more concerned about getting COVID-19 than straight

students and undergraduate students. The overall stress level was higher among students in lower

age groups, female students, full-time students, and Black students.

Insert Table 1

Prevalence of mental health issues by sample characteristics is displayed in Table 2.

Around 40% college students in lower age groups (18-25) reported they felt things were hopeless

in the last 30 days, the percentages were much greater than higher age groups’ percentages

(21.9% and 10.0%). However, compared with students who were between 26-30 years old,

students in lower age groups (18-25) reported feeling less overwhelmed and exhausted. Students

over 30 years old, male students, straight students, and part-time students had less percentages in

all eight mental health issues including feeling hopeless, overwhelmed, exhausted, lonely, sad,

depressed, anxiety, and anger.

Insert Table 2

Table 3 demonstrates the prevalence of eight mental health issues among all college

students, Black students, and LGBTQ students surveyed in our study during COVID-19 and

among same populations surveyed before COVID-19 during 2016-2018. Differences in

percentages during COVID-19 with percentages before COVID-19 are displayed in parentheses.

Among all college students surveyed, there were increased percentages of students who felt

hopeless (+7.8%), lonely (+6.7%), sad (+8.8%), depressed (+2.6%), anxious (5.2%), and angry
Mental health impacts of the COVID-19 pandemic on college students

(+14.6%) during COVID-19 than before. However, percentages of students feeling overwhelmed

(-9.8%) and exhausted (-4.9%) were smaller during COVID-19. Multiple regression predicting

overall mental health shows LGBTQ students (p = .003) and Black students (p = .005) had

significantly more negative mental health symptoms during the COVID-19 pandemic when

compared with straight students and students who identified themselves as White. Black students

exhibited increased prevalence in seven of the eight mental health issues during COVID-19

versus before, except for feeling overwhelmed by all they had to do (-9.8%). As opposed to the

general study sample, LGBTQ students had a slightly decreased percentage of anxiety (-0.1%)

during COVID-19 versus before. A horizontal comparison shows both Black students and

LGBTQ students surveyed during COVID-19 had higher prevalence of all eight mental health

symptoms than the general study sample surveyed during the same period. Black students and

LGBTQ students had a greater increase in percentages of students feeling overwhelming anger

(+21.6% and +22.8%) than the increase in percentage of that among general study sample

(+14.6%).

Insert table 3

Discussion

College students are considered at risk for mental health concerns at a time when they are

usually away from home and people that may be closely familiar with them. Mental health

disorders can affect their ability to achieve academic success and ultimately their career and job

prospects. A few studies have found that the pandemic has had an effect on anxiety and

depression among college students.19,20 The findings of this study revealed that the pandemic and

the subsequent transition to online/virtual learning had a negative effect on the mental health of

students. These findings are in line with a qualitative study conducted by Son and colleagues20
Mental health impacts of the COVID-19 pandemic on college students

that had similar findings which showed that the majority of students found that their stress and

anxiety had increased during the pandemic. While this was found, only 5% of the students

accessed mental health counseling.

In the all students* category the major increases in stress were seen in the areas of

hopelessness, sadness, loneliness, depression, anger and anxiety during COVID-19. Son and

colleagues20 found that financial difficulties, changes in the living arrangement, increased social

isolation and concerns about academic performance affected the student’s mental health during

the pandemic. The findings of this study revealed that the pandemic and the subsequent transition

to online/virtual learning had a negative effect on lifestyles habits such as exercise and

socializing with friends which can act as protective factors against mental health concerns.

Moving home was also a significant source of stress for the students. Moving home may

in the long run have provided more support for the students. However, because students were

isolated from friends and concerned about the health of the older relatives and parents that they

were now living with, this seemed to be a great source of anxiety. Moving home may have also

prevented them from accessing the mental health services available on the campus of the

university.

Students who identified as Black and LGBTQ experienced significantly more stress in

this study. The study was conducted during a time of great racial tension in the USA due to the

killing of several unarmed Black men by police and the resultant protests in several major cities.

Black students’ mental health and anxiety levels may have been affected by these events and

internalized racism. COVID-19 mortality rates have also been found to disproportionately affect

minority groups such as Blacks. Sexual minorities have been known to have poorer mental

health than heterosexual individuals. This mental health effect may be due to stigma and
Mental health impacts of the COVID-19 pandemic on college students

discrimination including sexual harassment.21 The Minority Stress Theory provides some lens

that may explain higher depressive symptoms among LGBTQ.22 This theory explains that

stigmatized individuals such as those identifying as a sexual minority experience chronic stress

that is thought to lead to a greater risk of poor mental health and physical health. The chronic

stress may occur as the result of sexual orientation concealment and internalized homophobia.23

Black and LGBTQ students experienced more overwhelming anger during the study period.

Social support has been shown to reduce psychological pressure during outbreaks but the

sudden isolation from friends due to the physical and social distancing requirements may have

significantly jeopardized peer social support. Students in these situations may find themselves

engaging in risky behaviors or using drugs and alcohol as coping mechanisms.

The findings of this study can be used to develop interventions for college students who

may be experiencing distress. Many students who obtained counseling on campus may not have

had a counselor that could have been accessed easily when they moved off campus as a result of

school closures. The absence of the peer networks may have had a significant impact on their

mental health. Social support is important during public health emergencies. While college

students were not in the high-risk categories for dying from COVID 19, their emotional needs

may have been overlooked by the health messages provided. It is essential that interventions that

can be delivered via the Internet or telehealth interventions be made available to students to

alleviate the prolonged impact of the pandemic on their mental health.

Limitations of the study included recruiting from one department of the university so this is

not a representative sample for the university and the findings cannot be generalized to all

college students in the USA. They may have generally practiced more health seeking behaviors.

However, given the fact that most universities transitioned to virtual/online learning during the
Mental health impacts of the COVID-19 pandemic on college students

pandemic we can expect that the findings may be able to be generalized. Future research should

incorporate a longitudinal design to understand if the impact of COVID-19 is long lasting and

may exist beyond the peak of COVID-19 as schools have mainly transitioned to months of

synchronous and asynchronous classes.

References

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16. Abbasalizad Farhangi M, Dehghan P, Jahangiry L. Mental health problems in relation to

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Mental health impacts of the COVID-19 pandemic on college students

Table 1. Sample Characteristics

Frequency (%) or Mean (Standard Deviation)

Self-rated

Susceptibility to

COVID-19 (1-4, Stress Level (1-5,

Sample Composition 4=very likely) 1=no stress)

Age

18-21 58.2% (273) 1.86 (0.73) 3.79 (0.81)

22-25 30.7% (144) 2.02 (0.84) 3.99 (0.74)

26-30 6.8% (32) 2.28 (0.68) 3.66 (0.83)

>30 4.3% (20) 1.90 (0.85) 3.65 (0.59)

Gender

Male 11.7% (57) 1.82 (0.83) 3.40 (0.90)

Female 88.3% (430) 1.95 (0.77) 3.89 (0.76)

Sexual Orientation

Straight 87.0% (422) 1.90 (0.76) 3.80 (0.78)

LGBTQ 13.0% (63) 2.13 (0.83) 4.08 (0.83)

Undergraduate

No 21.7% (105) 1.99 (0.73) 3.94 (0.66)

Yes 78.4% (380) 1.92 (0.78) 3.81 (0.82)

Full-time Student

No 12.0% (58) 2.09 (0.92) 3.72 (0.79)

Yes 88.0% (427) 1.92 (0.75) 3.85 (0.80)

Race

White 61.2% (299) 1.94 (0.74) 3.81 (0.78)

Black 22.3% (109) 1.81 (0.83) 3.94 (0.83)

Other 16.6% (81) 2.10 (0.83) 3.81 (0.79)

Fraternity or Sorority

Yes 10.0% (49) 1.92 (0.70) 3.86 (0.58)

No 90.0% (439) 1.94 (0.78) 3.83 (0.82)

THIS IS A PEER-REVIEWED, ACCEPTED AUTHOR MANUSCRIPT OF THE FOLLOWING RESEARCH ARTICLE: Wood, C. I., Yu, Z., Sealy, D-
A., Moss, I., Zugbuo-Wenzler, E., McFadden, C., Landi, D., & Brace, A. M. (2022). Mental health impacts of the COVID-19 pandemic on college
students. Journal of American College Health. https://doi.org/10.1080/07448481.2022.2040515

Table 2. Mental Health Issues by Sample Characteristics

In the last 30 days, students ever felt:

hopeless overwhelmed exhausted very lonely very sad depressed anxiety anger

Age

18-21 39.9% (109) 58.1% (158) 60.5% (164) 47.8% (130) 49.6% (135) 22.4% (61) 43.9% (119) 35.9% (98)

22-25 41.7% (60) 61.1% (88) 67.4% (97) 49.3% (71) 60.4% (87) 29.9% (43) 50.7% (73) 38.2% (55)

26-30 21.9% (7) 71.9% (23) 78.1% (25) 46.9% (15) 56.3% (18) 28.1% (9) 50.0% (16) 35.5% (11)

>30 10.0% (2) 40.0% (8) 50.0% (10) 20.0% (4) 20.0% (4) 5.0% (1) 15.0% (3) 10.0% (2)

Gender

Male 15.8% (9) 44.6% (25) 52.6% (30) 41.1% (23) 40.4% (23) 19.6% (11) 26.8% (15) 26.3% (15)

Female 40.2% (173) 60.7% (261) 63.8% (273) 47.4% (204) 53.4% (229) 25.1% (108) 47.3% (203) 36.8% (158)

Sexual Orientation

Straight 35.5% (150) 58.5% (247) 61.0% (256) 44.8% (189) 49.9% (210) 22.0% (93) 43.7% (184) 32.8% (138)

LGBTQ 50.8% (32) 60.3% (38) 71.4% (45) 58.7% (37) 65.1% (41) 39.7% (25) 52.4% (33) 52.4% (33)

Undergraduate

No 30.5% (32) 65.7% (69) 70.5% (74) 46.7% (49) 59.0% (62) 23.8% (25) 45.7% (48) 29.8% (31)

Yes 39.2% (149) 56.8% (216) 60.1% (227) 46.6% (177) 49.9% (189) 24.5% (93) 44.6% (169) 36.8% (140)

Full-time Student

No 20.7% (12) 52.6% (30) 60.3% (35) 40.4% (23) 46.6% (27) 19.3% (11) 31.6% (18) 34.5% (20)

Yes 39.6% (169) 59.5% (254) 62.6% (266) 47.5% (203) 52.3% (223) 25.3% (108) 46.7% (199) 35.7% (152)

Race

White 35.1% (105) 59.1% (176) 61.7% (184) 46.3% (138) 50.8% (152) 19.8% (59) 43.1% (128) 31.2% (93)

Black 45.9% (50) 63.3% (69) 73.1% (79) 51.4% (56) 58.7% (64) 37.6% (41) 54.1% (59) 46.8% (51)

Other 35.0% (28) 52.5% (42) 51.3% (41) 42.5% (34) 46.8% (37) 24.1% (19) 40.0% (32) 36.7% (29)

17
Mental health impacts of the COVID-19 pandemic on college students

Fraternity/Sorority

Yes 38.8% (19) 63.3% (31) 63.3% (31) 51.0% (25) 52.1% (25) 26.5% (13) 40.8% (20) 40.8% (20)

No 37.4% (164) 58.4% (256) 62.5% (273) 46.3% (203) 51.9% (228) 24.3% (106) 45.5% (199) 35.0% (153)
THIS IS A PEER-REVIEWED, ACCEPTED AUTHOR MANUSCRIPT OF THE FOLLOWING RESEARCH
ARTICLE: Wood, C. I., Yu, Z., Sealy, D-A., Moss, I., Zugbuo-Wenzler, E., McFadden, C., Landi, D., &
Brace, A. M. (2022). Mental health impacts of the COVID-19 pandemic on college students. Journal of
American College Health. https://doi.org/10.1080/07448481.2022.2040515
Table 3. Comparison of mental health issues during and before COVID-19

(Increased) Percentages among:

all students all students black black students LGBTQ LGBTQ

before during COVID- students during COVID- students students during

COVID-19 19 before 19 before COVID-19

COVID-19 COVID-19

In the last hopeless 30.1% 37.5% (+7.4%) 32.9% 45.9% (+13.0%) 42.4% 50.8% (+8.4%)

30 days, overwhelmed 68.7% 58.9% (-9.8%) 64.6% 63.3% (-1.3%) 74.5% 60.3% (-14.2%)

students exhausted 67.5% 62.6% (-4.9%) 63.5% 73.1% (+9.6%) 74.3% 71.4% (-2.9%)

ever felt: lonely 40.1% 46.8% (+6.7%) 40.9% 51.4% (+10.5%) 52.6% 58.7% (+6.1%)

sad 43.2% 52.0% (+8.8%) 44.0% 58.7% (+14.7%) 55.9% 65.1% (+9.2%)

depressed 21.9% 24.5% (+2.6%) 23.3% 37.6% (+14.3%) 35.6% 39.7% (+4.1%)

anxiety 39.9% 45.1% (+5.2%) 38.0% 54.1% (+16.1%) 52.5% 52.4% (-0.1%)

anger 22.0% 36.6% (+14.6%) 25.2% 46.8% (+21.6%) 29.6% 52.4%

(+22.8%)

19