This study examined commonly endured mental health challenges among emerging adults in college before, during, and after the COVID-19 pandemic. In this repeated cross-sectional study, different samples of undergraduates 18–26 years old were recruited from a large public university during pre-pandemic (Fall 2019, N = 500), pandemic onset (Spring 2020, N = 420), academic year 1 (Fall 2020-Spring 2021, N = 700), academic year 2 (Fall 2021-Spring 2022, N = 1,195), academic year 3 (Fall 2022-Spring 2023, N = 1,004), and post-pandemic (Fall 2023, N = 516). Participants completed an online survey assessing stress (Perceived Stress Scale-10), depression (Patient Health Questionnaire-8), and anxiety (Generalized Anxiety Disorder-7) symptoms. Quantitative analyses revealed similar patterns across all symptoms: greater symptoms in pandemic samples compared to the pre-pandemic sample, greatest symptoms in the academic year 2 sample, and similar symptom levels in pre- and post-pandemic samples. Our findings support the need to advocate for continued mental health resources throughout later stages of chronic stress endurance.
AlpizarD.PlunkettS. W.WhalingK. (2018). Reliability and validity of the 8-item Patient Health Questionnaire for measuring depressive symptoms of Latino emerging adults. Journal of Latina/o Psychology, 6(2), 115–130. https://doi.org/10.1037/lat0000087
2.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. text rev). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425787
3.
ArnettJ. J. (2000). Emerging adulthood. A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480. https://doi.org/10.1037/0003-066X.55.5.469
4.
ArnettJ. J. (2016). College students as emerging adults: The developmental implications of the college context. Emerging Adulthood, 4(3), 219–222. https://doi.org/10.1177/2167696815587422
5.
ArnettJ. J.ŽukauskienėR.SugimuraK. (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7
6.
AuerbachR. P.AlonsoJ.AxinnW. G.CuijpersP.EbertD. D.GreenJ. G.HwangI.KesslerR. C.LiuH.MortierP.NockM. K.Pinder-AmakerS.SampsonN. A.Aguilar-GaxiolaS.Al-HamzawiA.AndradeL. H.BenjetC.Caldas-de-AlmeidaJ. M.DemyttenaereK.BruffaertsR. (2016). Mental disorders among college students in the World health organization World mental health surveys. Psychological Medicine, 46(14), 2955–2970. https://doi.org/10.1017/S0033291716001665
7.
Bauer-StaebC.KounaliD. Z.WeltonN. J.GriffithE.WilesN. J.LewisG.FarawayJ. J.ButtonK. S. (2021). Effective dose 50 method as the minimal clinically important difference: Evidence from depression trials. Journal of Clinical Epidemiology, 137(September), 200–208. https://doi.org/10.1016/j.jclinepi.2021.04.002
8.
BerardiA.RuotoloI.SellittoG.PanuccioF.PolimeniA.ValenteD.TofaniM.GaleotoG. (2021). Criterion validity and reliability of Perceived Stress Scale (PSS) in a student population during COVID-19 pandemic. In SampsonD. G.IfenthalerD.IsaiasP. (Eds.), IADIS international conference on cognition and exploratory learning in digital age (pp. 71–728). International Association for Development of the Information Society. https://doi.org/10.33965/celda2021_202108L009
9.
BritoA. D.SoaresA. B. (2023). Well-being, character strengths, and depression in emerging adults. Frontiers in Psychology, 14(September 20), 1238105. https://doi.org/10.3389/fpsyg.2023.1238105
10.
BuizzaC.BazzoliL.GhilardiA. (2022). Changes in college students’ mental health and lifestyle during the COVID-19 pandemic: A systematic review of longitudinal studies. Adolescent Research Review, 7(4), 537–550. https://doi.org/10.1007/s40894-022-00192-7
11.
Center for Collegiate Mental Health. (2019). 2019 annual report. Penn State University.
12.
CeroliniS.ZagariaA.FranchiniC.ManiaciV. G.FortunatoA.PetrocchiC.SperanzaA. M.LombardoC. (2023). Psychological counseling among university students worldwide: A systematic review. European Journal of Investigation in Health Psychology and Education, 13(9), 1831–1849. https://doi.org/10.3390/ejihpe13090133
13.
CharlesN. E.StrongS. J.BurnsL. C.BullerjahnM. R.SerafineK. M. (2021). Increased mood disorder symptoms, perceived stress, and alcohol use among college students during the COVID-19 pandemic. Psychiatry Research, 296(February), 113706. https://doi.org/10.1016/j.psychres.2021.113706
14.
ClabaughA.DuqueJ. F.FieldsL. J. (2021). Academic stress and emotional well-being in United States college students following onset of the COVID-19 pandemic. Frontiers in Psychology, 12(March 17), 628787. https://doi.org/10.3389/fpsyg.2021.628787
15.
CohenS.WilliamsonG.M. (1988). Perceived stress in a probability sample of the United States. In SpacapanS.OskampS. (Eds.), The social psychology of health (pp. 31–67). Sage.
16.
ConderL.VanacoreS.SimonA.DolbierC. (2023). COVID-19 appraisals and stressors among college students with and without disabilities. Journal of Postsecondary Education and Disability, 36(3), 289–308.
17.
DolbierC.VanacoreS.ConderL.GuilerW. (2023). A mixed-methods investigation of COVID-19 pandemic-specific stress in college students. Journal of American College Health: J of ACH, 18(4), 1–13. https://doi.org/10.1080/07448481.2023.2253929
18.
DolbierC.VanacoreS.SimonA.StallingsT.SignorelliJ.DietrichK. M. (2024). A mixed-method investigation of trends in pandemic-specific positive changes across three academic years following pandemic onset. Journal of College Student Development, 65(6), 609–626. https://doi.org/10.1353/csd.2024.a944810
19.
Durand-BushN.McNeillK.HardingM.DobranskyJ. (2015). Investigating stress, psychological well-being, mental health functioning, and self-regulation capacity among university undergraduate students: Is this population optimally functioning?Canadian Journal of Counselling and Psychotherapy, 49(3), 253–274. https://cjc-rcc.ucalgary.ca/article/view/61066.
20.
FaulF.ErdfelderE.LangA.BuchnerA. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/bf03193146
21.
FrazierP.LiuY.AsplundA.MeredithL.Nguyen-FengV. N. (2023). US college student mental health and COVID-19: Comparing pre-pandemic and pandemic timepoints. Journal of American College Health: J of ACH, 71(9), 2686–2696. https://doi.org/10.1080/07448481.2021.1987247
22.
FruehwirthJ. C.BiswasS.PerreiraK. M. (2021). The Covid-19 pandemic and mental health of first-year college students: Examining the effect of Covid-19 stressors using longitudinal data. PLoS One, 16(3), Article e0247999. https://doi.org/10.1371/journal.pone.0247999
23.
GoodwinR. D.WeinbergerA. H.KimJ. H.WuM.GaleaS. (2020). Trends in anxiety among adults in the United States, 2008-2018: Rapid increases among young adults. Journal of Psychiatric Research, 130(November), 441–446. https://doi.org/10.1016/j.jpsychires.2020.08.014
24.
HarveyJ. B.ValentaS.SimpsonK.LylesM.McElligottJ. (2019). Utilization of outpatient telehealth services in parity and nonparity states 2010-2015. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 25(2), 132–136. https://doi.org/10.1089/tmj.2017.0265
25.
HotezE.GragnaniC. M.FernandesP.RosenauK. A.WangK.ChopraA.ChowK.ChungA.KhorasaniL.KuoA. A. (2022). A mixed methods investigation of college student mental health during the first year of the COVID-19 pandemic. Journal of American College Health: J of ACH, 72(5), 1632–1639. https://doi.org/10.1080/07448481.2022.2089842
26.
HouserS. H.FliteC. A.FosterS. L. (2023). Privacy and security risk factors related to telehealth services: A systematic review. Perspectives in Health Information Management, 20(1), 1f.
27.
HuckinsJ. F.daSilvaA. W.WangW.HedlundE.RogersC.NepalS. K.WuJ.ObuchiM.MurphyE. I.MeyerM. L.WagnerD. D.HoltzheimerP. E.CampbellA. T. (2020). Mental Health and behavior of college students during the early phases of the COVID-19 pandemic: Longitudinal smartphone and ecological momentary assessment study. Journal of Medical Internet Research, 22(6), Article e20185. https://doi.org/10.2196/20185
28.
IbrahimA. K.KellyS. J.AdamsC. E.GlazebrookC. (2013). A systematic review of studies of depression prevalence in university students. Journal of Psychiatric Research, 47(3), 391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015
29.
IngramR. E.LuxtonD. D. (Eds.), (2005). Development of psychopathology: A vulnerability-stress perspective. Sage Publications, Inc.
30.
JeongH. J.KimS.LeeJ. (2021). Mental health, life satisfaction, supportive parent communication, and help-seeking sources in the wake of COVID-19: First-generation college students (FGCS) vs. non-first-generation college students (non-FGCS). Journal of College Student Psychotherapy, 37(2), 71–86. https://doi.org/10.1080/87568225.2021.1906189
31.
KesslerR.AmmingerG.Aguilar-GaxiolaS.AlonsoJ.LeeS.ÜstünT. (2007). Age of onset of mental disorders: A review of recent literature. Current Opinion in Psychiatry, 20(4), 359–364. https://doi.org/10.1097/YCO.0b013e32816ebc8c
32.
LazarusR. S.FolkmanS. (1984). Stress, appraisal, and coping. Springer Publishing Company.
33.
LeeJ.JeongH. J.KimS. (2021). Stress, anxiety, and depression among undergraduate students during the COVID-19 pandemic and their use of mental health services. Innovative Higher Education, 46(5), 519–538. https://doi.org/10.1007/s10755-021-09552-y
34.
LiuC. H.StevensC.WongS. H. M.YasuiM.ChenJ. A. (2019). The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. Depression and Anxiety, 36(1), 8–17. https://doi.org/10.1002/da.22830
35.
López-CastroT.BrandtL.AnthonipillaiN. J.EspinosaA.MelaraR. (2021). Experiences, impacts and mental health functioning during a COVID-19 outbreak and lockdown: Data from a diverse New York City sample of college students. PLoS One, 16(4), Article e0249768. https://doi.org/10.1371/journal.pone.0249768
36.
LöweB.UnützerJ.CallahanC. M.PerkinsA. J.KroenkeK. (2004). Monitoring depression treatment outcomes with the patient health questionnaire-9. Medical Care, 42(12), 1194–1201. https://doi.org/10.1097/00005650-200412000-00006
37.
MarinM.LordC.AndrewsJ.JusterR.SindiS.Arsenault-LapierreG.FioccoA.LupienS. (2011). Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory, 96(4), 583–595. https://doi.org/10.1016/j.nlm.2011.02.016
38.
McCloudT.KamenovS.CallenderC.LewisG.LewisG. (2023). The association between higher education attendance and common mental health problems among young people in England: Evidence from two population-based cohorts. The Lancet Public Health, 8(10), e811–e819. https://doi.org/10.1016/S2468-2667(23)00188-3
39.
McEwenB. S. (2004). Protection and damage from acute and chronic stress: Allostasis and allostatic overload and relevance to the pathophysiology of psychiatric disorders. Annals of the New York Academy of Sciences, 1032(December), 1–7. https://doi.org/10.1196/annals.1314.001
40.
NielsenT.DammeyerJ. (2019). Measuring higher education students’ perceived stress: An IRT-based construct validity study of the PSS-10. Studies In Educational Evaluation, 63(December), 17–25. https://doi.org/10.1016/j.stueduc.2019.06.007
41.
OswaltS. B.LedererA. M.Chestnut-SteichK.DayC.HalbritterA.OrtizD. (2020). Trends in college students’ mental health diagnoses and utilization of services, 2009-2015. Journal of American College Health: J of ACH, 68(1), 41–51. https://doi.org/10.1080/07448481.2018.1515748
42.
ParkC.McClure FullerM.EchevarriaT. M.NguyenK.PerezD.MasoodH.AlsharifT.WorthenM. (2023). A participatory study of college students’ mental health during the first year of the COVID-19 pandemic. Frontiers in Public Health, 11(March 21), 1116865. https://doi.org/10.3389/fpubh.2023.1116865
43.
PatiasN. D.HohendorffJ. V.CozzerA. J.FloresP. A.Scorsolini-CominF. (2021). Mental health and coping strategies in undergraduate students during COVID-19 pandemic. Trends in Psychology, 29(3), 414–433. https://doi.org/10.1007/s43076-021-00069-z
44.
PattersonZ. R.GabrysR. L.ProwseR. K.AbizaidA. B.HellemansK. G. C.McQuaidR. J. (2021). The influence of COVID-19 on stress, substance use, and mental health among postsecondary students. Emerging Adulthood, 9(5), 516–530. https://doi.org/10.1177/21676968211014080
45.
PedrelliP.NyerM.YeungA.ZulaufC.WilensT. (2015). College students: Mental health problems and treatment considerations. Academic Psychiatry: The Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 39(5), 503–511. https://doi.org/10.1007/s40596-014-0205-9
46.
Pérez-RojasA. E.LockardA. J.BartholomewT. T.JanisR. A.CarneyD. M.XiaoH.YounS. J.ScofieldB. E.LockeB. D.CastonguayL. G.HayesJ. A. (2017). Presenting concerns in counseling centers: The view from clinicians on the ground. Psychological Services, 14(4), 416–427. https://doi.org/10.1037/ser0000122
47.
RobertsM. E.BellE. A.MeyerJ. L. (2023). Mental health and academic experiences among U.S. college students during the COVID-19 pandemic. Frontiers in Psychology, 14(April 27), 1166960. https://doi.org/10.3389/fpsyg.2023.1166960
48.
RossR. A.FosterS. L.IonescuD. F. (2017). The role of chronic stress in anxious depression. Chronic Stress, 1(February 17), 2470547016689472. https://doi.org/10.1177/2470547016689472
49.
RutterL. A.BrownT. A. (2017). Psychometric properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in outpatients with anxiety and mood disorders. Journal of Psychopathology and Behavioral Assessment, 39(1), 140–146. https://doi.org/10.1007/s10862-016-9571-9
50.
SalimiN.GereB.TalleyW.IrioogbeB. (2021). College students’ mental health challenges: Concerns and considerations in the COVID-19 pandemic. Journal of College Student Psychotherapy, 37(1), 39–51. https://doi.org/10.1080/87568225.2021.1890298
51.
SeidelE. J.MohlmanJ.BaschC. H.FeraJ.CosgroveA.EthanD. (2020). Communicating mental health support to college students during COVID-19: An exploration of website messaging. Journal of Community Health, 45(6), 1259–1262. https://doi.org/10.1007/s10900-020-00905-w
52.
ShinC.LeeS.-H.HanK.-M.YoonH.-K.HanC. (2019). Comparison of the usefulness of the PHQ-8 and PHQ-9 for screening for major depressive disorder: Analysis of psychiatric outpatient data. Psychiatry Investigation, 16(4), 300–305. https://doi.org/10.30773/pi.2019.02.01
53.
SistaniF.Rodriguez de BittnerM.ShayaF. T. (2022). COVID-19 pandemic and telemental health policy reforms. Current Medical Research and Opinion, 38(12), 2123–2126. https://doi.org/10.1080/03007995.2022.2096355
54.
SolmiM.RaduaJ.OlivolaM.CroceE.SoardoL.Salazar de PabloG.Il ShinJ.KirkbrideJ. B.JonesP.KimJ. H.KimJ. Y.CarvalhoA. F.SeemanM. V.CorrellC. U.Fusar-PoliP. (2021). Age at onset of mental disorders worldwide: Large-scale meta-analysis of 192 epidemiological studies. Molecular Psychiatry, 27(1), 281–295. https://doi.org/10.1038/s41380-021-01161-7
55.
SonC.HegdeS.SmithA.WangX.SasangoharF. (2020). Effects of COVID-19 on college students’ mental health in the United States: Interview survey study. Journal of Medical Internet Research, 22(9), Article e21279. https://doi.org/10.2196/21279
56.
SoriaK. M.KellingC.MossinghoffM.BeahmR. (2022). First-generation college students’ mental health during the COVID-19 pandemic. Journal of First-Generation Student Success, 2(2), 97–117. https://doi.org/10.1080/26906015.2022.2070442
57.
SpitzerR. L.KroenkeK.WilliamsJ. B. W.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
58.
SrikenJ.JohnsenS. T.SmithH.ShermanM. F.ErfordB. T. (2022). Testing the factorial validity and measurement invariance of college student scores on the Generalized Anxiety Disorder (GAD-7) Scale across gender and race. Measurement and Evaluation in Counseling and Development, 55(1), 1–16. https://doi.org/10.1080/07481756.2021.1902239
59.
StepanovaE.ThompsonA.YuG.FuY. (2024). Changes in mental health services in response to the COVID-19 pandemic in high-income countries: A rapid review. BMC Psychiatry, 24(1), 103. https://doi.org/10.1186/s12888-024-05497-6
60.
TaylorC. B.Fitzsimmons-CraftE. E.GrahamA. K. (2020). Digital technology can revolutionize mental health services delivery: The COVID-19 crisis as a catalyst for change. International Journal of Eating Disorders, 53(7), 1155–1157. https://doi.org/10.1002/eat.23300
61.
TompsettJ.KnoesterC. (2023). Family socioeconomic status and college attendance: A consideration of individual-level and school-level pathways. PLoS One, 18(4), Article e0284188. https://doi.org/10.1371/journal.pone.0284188
62.
ToussaintA.HüsingP.GumzA.WingenfeldK.HärterM.SchrammE.LöweB. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of Affective Disorders, 265(March 15), 395–401. https://doi.org/10.1016/j.jad.2020.01.032
Von KeyserlingkL.Yamaguchi‐PedrozaK.ArumR.EcclesJ. S. (2021). Stress of university students before and after campus closure in response to COVID‐19. Journal of Community Psychology, 50(1), 285–301. https://doi.org/10.1002/jcop.22561
65.
WagnerB.SnoubarY.MahdiY. S. (2023). Access and efficacy of university mental health services during the COVID-19 pandemic. Frontiers in Public Health, 11(December 20), 1269010. https://doi.org/10.3389/fpubh.2023.1269010
66.
WatheletM.HornM.CreupelandtC.FovetT.BaubetT.HabranE.MartignèneN.VaivaG.D'HondtF. (2022). Mental health symptoms of university students 15 months after the onset of the COVID-19 pandemic in France. JAMA Network Open, 5(12), Article e2249342. https://doi.org/10.1001/jamanetworkopen.2022.49342
67.
WhiteA. E.KarrJ. E. (2023). Psychometric properties of the GAD-7 among college students: Reliability, validity, factor structure, and measurement invariance. Translational Issues in Psychological Science. https://doi.org/10.1037/tps0000382
WosikJ.FudimM.CameronB.GelladZ. F.ChoA.PhinneyD.CurtisS.RomanM.PoonE. G.FerrantiJ.KatzJ. N.TchengJ. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association: JAMIA, 27(6), 957–962. https://doi.org/10.1093/jamia/ocaa067
70.
WuY.LevisB.RiehmK. E.SaadatN.LevisA. W.AzarM.RiceD. B.BoruffJ.CuijpersP.GilbodyS.IoannidisJ. P. A.KlodaL. A.McMillanD.PattenS. B.ShrierI.ZiegelsteinR. C.AkenaD. H.ArrollB.AyalonL.ThombsB. D. (2020). Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: A systematic review and individual participant data meta-analysis. Psychological Medicine, 50(8), 1368–1380. https://doi.org/10.1017/S0033291719001314
71.
XiaoH.CarneyD. M.YounS. J.JanisR. A.CastonguayL. G.HayesJ. A.LockeB. D. (2017). Are we in crisis? National mental health and treatment trends in college counseling centers. Psychological Services, 14(4), 407–415. https://doi.org/10.1037/ser0000130
72.
ZarowskiB.GiokarisD.GreenO. (2024). Effects of the COVID-19 pandemic on university students' mental health: A literature review. Cureus, 16(2), Article e54032. https://doi.org/10.7759/cureus.54032
73.
ZimmermannM.BledsoeC.PapaA. (2021). Initial impact of the COVID-19 pandemic on college student mental health: A longitudinal examination of risk and protective factors. Psychiatry Research, 305(November). https://doi.org/10.1016/j.psychres.2021.114254
74.
ZivinK.EisenbergD.GollustS. E.GolbersteinE. (2009). Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders, 117(3), 180–185. https://doi.org/10.1016/j.jad.2009.01.001
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
