A Qualitative Study of COVID-19 Distress in University Students

Abstract

The psychological effect of the pandemic and measures taken in response to control viral spread are not yet well understood in university students; in-depth qualitative analysis can provide nuanced information about the young adult distress experience. Undergraduate students (N = 624) in an early US outbreak “hotspot” completed an online narrative writing about the impact and distress experienced due to the COVID-19 pandemic. Data were collected April-May 2020. A random selection of 50 cases were sampled for thematic analysis. Nine themes were identified: viral outbreak distress, fear of virus contraction/transmission, proximity to virus, dissatisfaction with public response, physical distancing distress, social distancing distress, academic and school-related distress, disruptive changes in health behavior and routines, financial strain and unemployment, worsening of pre-existing mental health problems, and social referencing that minimizes distress. Future work is needed to understand the persistence of the distress, in addition to developing methods for assessment, monitoring, and mitigation of the distress.

Keywords

COVID-19 stress university students life events virus

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References

American Psychological Association. (2020). Stress in America^TM 2020: A national mental health crisis. American Psychological Association.

Arnett

J. J.

(2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68–73. https://doi.org/10.1111/j.1750-8606.2007.00016.x

Asmundson

G. J. G.

Taylor

(2020). Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of Anxiety Disorders, 70. https://doi.org/10.1016/j.janxdis.2020.102196

Beiter

Nash

McCrady

Rhoades

Linscomb

Clarahan

Sammut

(2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90–96. https://doi.org/10.1016/j.jad.2014.10.054

Blanco

Okuda

Wright

Hasin

D. S.

Grant

B. F.

Liu

S. M.

Olfson

(2008). Mental health of college students and their non-college-attending peers: Results from the national epidemiologic study on alcohol and related conditions. Archives of General Psychiatry, 65(12), 1429–1437. https://doi.org/10.1001/archpsyc.65.12.1429

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa

Braun

Clarke

Hayfield

Terry

(2019). Thematic analysis. In Handbook of research methods in health social sciences (pp. 843–860). Springer Singapore. https://doi.org/10.1007/978-981-10-5251-4_103

Braunack-Mayer

Tooher

Collins

J. E.

Street

J. M.

Marshall

(2013). Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-344

Bree

R. T.

Gallagher

(2016). Using Microsoft Excel to code and thematically analyse qualitative data: A simple, cost-effective approach. All Ireland Journal of Higher Education, 8(2), 2811–2819.

10.

Brooks

S. K.

Webster

R. K.

Smith

L. E.

Woodland

Wessely

Greenberg

Rubin

G. J.

(2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet, 395(10227), 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8

11.

Cao

Fang

Hou

Han

Dong

Zheng

(2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 112934. https://doi.org/10.1016/j.psychres.2020.112934

12.

Cava

M. A.

Fay

K. E.

Beanlands

H. J.

McCay

E. A.

Wignall

(2005). The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing, 22(5), 398–406. https://doi.org/10.1111/j.0737-1209.2005.220504.x

13.

Centers for Disease Control and Prevention. (2020). Cases in the U.S. Coronavirus disease 2019 (COVID-19). https://covid.cdc.gov/covid-data-tracker/

14.

Cheung

C. K.

Tse

J. W. L.

(2008). Institutional trust as a determinant of anxiety during the sars crisis in Hong Kong. Social Work in Public Health, 23(5), 41–54. https://doi.org/10.1080/19371910802053224

15.

Denzin

N. K.

(1989). Interpretive interactionism. Sage.

16.

DiGiovanni

Conley

Chiu

Zaborski

(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. https://doi.org/10.1089/bsp.2004.2.265

17.

Duffy

M. E.

Twenge

J. M.

Joiner

T. E.

(2019). Trends in mood and anxiety symptoms and suicide-related outcomes among U.S. Undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590–598. https://doi.org/10.1016/j.jadohealth.2019.04.033

18.

Fedorenko

E. J.

Kibbey

M. M.

Contrada

R. J.

Farris

S. G.

(2021). Psychosocial predictors of virus and social distancing fears in undergraduate students living in a US COVID-19 “hotspot”. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506073.2020.1866658

19.

Garris

C. P.

Fleck

(2020). Student evaluations of transitioned-online courses during the COVID-19 pandemic. Scholarship of Teaching and Learning in Psychology. https://doi.org/10.1037/stl0000229

20.

Germani

Buratta

Delvecchio

Mazzeschi

(2020). Emerging adults and COVID-19: The role of individualism-collectivism on perceived risks and psychological maladjustment. International Journal of Environmental Research and Public Health, 17(10), 3497. https://doi.org/10.3390/ijerph17103497

21.

Glowacz

Schmits

(2020). Psychological distress during the COVID-19 lockdown: The young adults most at risk. Psychiatry Research, 293, 113486. https://doi.org/10.1016/j.psychres.2020.113486

22.

Goodwin

R. D.

Weinberger

A. H.

Kim

J. H.

Galea

(2020). Trends in anxiety among adults in the United States, 2008–2018: Rapid increases among young adults. Journal of Psychiatric Research, 130, 441–446. https://doi.org/10.1016/j.jpsychires.2020.08.014

23.

Kibbey

M. M.

Fedorenko

E. J.

Farris

S. G.

(2021). Anxiety, depression, and health anxiety in undergraduate students living in initial US outbreak “hotspot” during COVID-19 pandemic. Cognitive Behaviour Therapy, 1–13. https://doi.org/10.1080/16506073.2020.1853805

24.

Kujawa

Green

Compas

B. E.

Dickey

Pegg

(2020). Exposure to COVID-19 pandemic stress: Associations with depression and anxiety in emerging adults in the United States. Depression and Anxiety, 37(12), 1280–1288. https://doi.org/10.1002/da.23109

25.

Lee

S. A.

(2020). Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Studies, 44(7), 393–401. https://doi.org/10.1080/07481187.2020.1748481

26.

Makwana

(2019). Disaster and its impact on mental health: A narrative review. Journal of Family Medicine and Primary Care, 8(10), 3090–3095. https://doi.org/10.4103/jfmpc.jfmpc_893_19

27.

Mason

(2002). Qualitative researching (2nd ed.). Sage.

28.

Meyer

D. Z.

Avery

L. M.

(2009). Excel as a qualitative data analysis tool. Field Methods, 21(1), 91–112. https://doi.org/10.1177/1525822X08323985

29.

Mojtabai

Olfson

Han

(2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138(6). https://doi.org/10.1542/peds.2016-1878

30.

Nowell

L. S.

Norris

J. M.

White

D. E.

Moules

N. J.

(2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16(1), 160940691773384. https://doi.org/10.1177/1609406917733847

31.

Olatunji

B. O.

Etzel

E. N.

Tomarken

A. J.

Ciesielski

B. G.

Deacon

(2011). The effects of safety behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy, 49(11), 719–728. https://doi.org/10.1016/j.brat.2011.07.008

32.

Paluszek

M. M.

Landry

Taylor

Asmundson

G. J. G.

(2020). The psychological sequelae of the COVID-19 pandemic: Psychological processes, current research ventures, and preparing for a postpandemic world. The Behavior Therapist, 43(5), 158–165.

33.

Pan

P. J. D.

Chang

S. H.

Y. Y.

(2005). A support group for home-quarantined college students exposed to SARS: Learning from practice. Journal for Specialists in Group Work, 30(4), 363–374. https://doi.org/10.1080/01933920500186951

34.

Pfefferbaum

North

C. S.

(2020). Mental health and the Covid-19 pandemic. New England Journal of Medicine, 1–4. https://doi.org/10.1056/NEJMp2009027

35.

Qiu

Shen

Zhao

Wang

Xie

(2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. General Psychiatry, 33(2), 19–21. https://doi.org/10.1136/gpsych-2020-100213

36.

Reiss

Peterson

R. A.

Gursky

D. M.

McNally

R. J.

(1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24(1), 1–8. https://doi.org/10.1016/0005-7967(86)90143-9

37.

Reynolds

D. L.

Garay

J. R.

Deamond

S. L.

Moran

M. K.

Gold

Styra

(2008). Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology and Infection, 136(7), 997–1007. https://doi.org/10.1017/S0950268807009156

38.

Sahu

(2020). Closure of universities due to coronavirus disease 2019 (COVID-19): Impact on education and mental health of students and academic staff. Cureus, 12(4). https://doi.org/10.7759/cureus.7541

39.

Salkovskis

P. M.

(1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 19(1), 6–9. https://doi.org/10.1017/S0141347300011472

40.

Salkovskis

P. M.

(1996). The cognitive approach to anxiety: Threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions. In Salkovskis

P. M.

(Ed.), Frontiers of cognitive therapy (pp. 48–74). The Guilford Press.

41.

Salkovskis

P. M.

Warwick

H. M. C.

(2001). Meaning, misinterpretation and medicine : A cognitive-behavioral approach to understanding health anxiety and hypochondriasis. In Starcevic

Lipsitts

D. R.

(Eds.), Hypochondriasis : Modern perspectives on an ancient malady (pp. 202–222). Oxford University Press.

42.

Sandelowski

(1995). Sample size in qualitative research. Research in Nursing & Health, 18(2), 179–183. https://doi.org/10.1002/nur.4770180211

43.

Schimmenti

Billieux

Starcevic

(2020). The four horsemen of fear: An integrated model of understanding fear experiences during the COVID-19 pandemic. Clinical Neuropsychiatry, 17(2), 41–45. https://doi.org/10.36131/CN20200202

44.

Shanahan

Steinhoff

Bechtiger

Murray

A. L.

Nivette

Hepp

Ribeaud

Eisner

(2020). Emotional distress in young adults during the covid-19 pandemic: Evidence of risk and resilience from a longitudinal cohort study. Psychological Medicine, 1–10. https://doi.org/10.1017/S003329172000241X

45.

Sim

Saunders

Waterfield

Kingstone

(2018). Can sample size in qualitative research be determined a priori? International Journal of Social Research Methodology: Theory & Practice, 21(5), 619–634. https://doi.org/10.1080/13645579.2018.1454643

46.

Svoboda

Henry

Shulman

Kennedy

Rea

Wallington

Yaffe

Gournis

Vicencio

Basrur

Glazier

R. H.

(2004). Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto. New England Journal of Medicine, 350(23), 2352–2361.

47.

Taylor

Asmundson

G. J. G.

(2004). Treating health anxiety: A cognitive behavioral approach. Guilford Press.

48.

Taylor

Asmundson

G. J. G.

(2020). Life in a post-pandemic world: What to expect of anxiety-related conditions and their treatment. Journal of anxiety disorders, 72, 102231. https://doi.org/10.1016/j.janxdis.2020.102231

49.

Taylor

Landry

C. A.

Paluszek

M. M.

Fergus

T. A.

McKay

Asmundson

G. J. G.

(2020a). COVID stress syndrome: Concept, structure, and correlates. Depression and Anxiety, da.23071. https://doi.org/10.1002/da.23071

50.

Taylor

Landry

C. A.

Paluszek

M. M.

Fergus

T. A.

McKay

Asmundson

G. J. G.

(2020b). Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders, 72, 102232. https://doi.org/10.1016/j.janxdis.2020.102232

51.

Van Den Bulck

Custers

(2009). Television exposure is related to fear of avian flu, an ecological study across 23 member states of the European Union. European Journal of Public Health, 19(4), 370–374. https://doi.org/10.1093/eurpub/ckp061

52.

Wong

T. W.

Gao

Tam

W. W. S.

(2007). Anxiety among university students during the SARS epidemic in Hong Kong. Stress and Health, 23(1), 31–35. https://doi.org/10.1002/smi.1116

53.

World Health Organization. (2020). Coronavirus disease (COVID-19) pandemic. https://covid19.who.int/

54.

Xiang

Y.-T.

Yang

Zhang

Cheung

C. H.

(2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. 7, 228–229. https://doi.org/10.1016/S2215-0366(20)30046-8

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