key: cord-318817-95tw84z8 authors: Hubner, C. v. K.; Bruscatto, M. L.; Lima, R. D. title: Distress among Brazilian university students due to the Covid-19 pandemic: survey results and reflections date: 2020-06-20 journal: nan DOI: 10.1101/2020.06.19.20135251 sha: doc_id: 318817 cord_uid: 95tw84z8 The first case of infection with the new coronavirus was identified in December 2019 in Wuhan, China. In March, the World Health Organization (WHO) defined the disease epidemic as a pandemic. Thus, a quarantine was imposed by many governments. As a consequence, and given that epidemiological outbreaks of infectious diseases, such as Covid-19, are associated with psychological disorders and symptoms of mental illness, researchers at the Shanghai Mental Health Center have created the Covid-19 Peritraumatic Distress Index (CPDI), in which the results are obtained: normal, mild/moderate distress and severe distress. The main objective of the study was based on the application of CPDI, in order to identify the health and well-being of Brazilian students from different undergraduate courses at the Pontifical Catholic University of Sao Paulo (PUC/SP) during the Covid-19 pandemic and to test the hypothesis that medical students suffer more than students from other courses. The research is based on a cross-sectional observational study, in which we applied, using Google FormsR, the questions contained in CPDI, among with demographic data: age, sex, educational institution, undergraduate course and school year. The Index was applied online for seven days in which a total of 654 valid responses were obtained: 501 (76.6%) female and 149 (22.8%) male. Regarding age, 333 students (50.91%) were 17-20 years old, 279 (42.66%) between 21-25, 30 (4.59%) between 26-30 and 12 (1.84%) between 31-50. The results indicate that the participants reported significant psychological distress, according to the CPDI score. Practically 90% (87.92%) of the students experienced suffering, while only 12.08% did not suffer. The study provides the first empirical evidence on the level of psychological distress in Brazilian university students during the Covid-19 pandemic. Also, it suggests support and monitoring of university students during and after the pandemic, with effective and efficient intervention in their mental health. The first case of infection by the new coronavirus was identified in December 2019, in Wuhan, China 1 . Since then, cases have spread rapidly across the world. In February, Brazil's first case was identified in São Paulo. At April 24, 2020, in the country, there were 52,995 confirmed cases and 3670 deaths, while in the world the number of cases totals 2.79 million and a total of 196 thousand deaths 2 . In March, the World Health Organization (WHO) defined the disease epidemic as a progressive pandemic. 3 Covid-19, the name given to the disease caused by the new coronavirus, SARS-CoV2 4 , despite not having its pathophysiology completely elucidated, presents with a clinical picture of pneumonia, fever, difficulty breathing and pulmonary infection 5, 6 , associated with a disseminated intravascular coagulation (DIC) 7, 8 . As it is a disease whose transmissibility occurs through one sick person to another or through close contact 9 , the best form of prevention is social isolation 10 . Therefore, quarantine was established by many governments. As a consequence, and given that epidemiological outbreaks of infectious diseases, such as Covid-19, are associated with psychological distress and symptoms of mental illness [11] [12] [13] , many people have their lives impacted and this should have an important impact on their health, since in 1947 the WHO developed the concept of health as "a state of complete physical, mental and social well-being and not just the absence of disease or infirmity" 14 . For instance, it is worth mentioning that medical students in China, during the pandemic, experienced more stress and anxiety. 15 Researchers at the Shanghai Mental Health Center, during the epidemic, developed a questionnaire to research and assess the level of peritraumatic distress specific to Covid-19. The word distress represents an act or effect of suffering, physical pain, anguish, affliction, bitterness, patience and resignation 16 The main objective of the study was based on the application of the Covid-19 Peritraumatic Distress Index, in order to identify the health and well-being of Brazilian students from different undergraduate courses at the Pontifical Catholic University of São Paulo (PUC/SP) during the Covid-19 pandemic and to test the hypothesis that medical students suffer more than students from other courses. Besides that, quantify the prevalence and severity of psychological distress in the sample studied, and therefore provide data to adapt and implement relevant mental health intervention policies to deal with this challenge in an efficient and effective manner, prioritizing assistance to psychologically affected people. University of São Paulo, was voluntary, and we assured the participants confidentiality and anonymity of their responses, evidenced by the free and informed consent term (can be seen in the appendix), in which the participants had to read and accept it in order to answer it. The inclusion criteria used were undergraduate students, specifically from the Pontifical Catholic University of São Paulo, using the electronic form. Those who were not undergraduate students enrolled at the Pontifical Catholic University of São Paulo were excluded, as well as those who, perhaps, were not actively enrolled. The study uses a cross-sectional observational analytical primary study design, evaluating medical students and other undergraduate courses at PUC/SP. To them it was sent a semi-structured and self-administered questionnaire, answered electronically, using Google Forms R , with the questions contained in CPDI along with demographic data: age, gender, educational institution, undergraduate course and the respective academic year. The Questionnaire contains 24 questions, each of which has 5 answers, whose score is 0 to 4 points for each question. At the end of the questionnaire, the result is obtained from the sum of the answers in addition to the sum of 4 more points. Finally, the points of the responses of each participant, individually, will be added to reach a score. Thus, the compiled data will be analyzed according to the following statistics: 1. Description of the distribution of absolute and relative frequencies of the variable degrees of suffering, age, gender, course and grade; . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 20, 2020. . https://doi.org/10.1101/2020.06.19.20135251 doi: medRxiv preprint 2. Description of the mean and standard deviation of the suffering score variable. 3. Analysis of differences in suffering scores according to age, gender, course and grade, with special attention to the medical school and its boarding school, using linear regression. For all tests, a significance level of 0.05, bilateral, were adopted. The English and Portuguese versions of CPDI, as well as its scoring key can be found in the appendix. The COVID-19 Peritraumatic Distress Index (CPDI) was applied online for seven days, from 12 May 2020 to 18 May 2020, in which a total of 764 responses were obtained. Of these, 110 were excluded, as these participants did not belong to (Table 1) . . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 20, 2020. Languages 0 (0%) 6 (0,918%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 6 (0,918%) Social Service 13 (1,988%) 0 (0%) 0 (0%) 0 (0%) 1 (0,153%) 0 (0%) 14 (2,141%) Theology 0 (0%) 0 (0%) 0 (0%) 2 (0,306%) 0 (0%) 0 (0%) 2 (0,306%) It is important to point out that when the research was started the state of São Paulo, where the University is located, in Brazil, was already in its 50th day of . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 20, 2020. 18 Based on these data, it is possible to speculate a correlation between the increase in psychological distress and these stressors. Through statistical analysis of multiple linear regression, a high rate of peri traumatic distress was associated with the female gender, with undergraduate courses that not Medicine and with non-medical interns. The women who responded showed higher psychological distress when compared to men (mean (SD) = 47.14 Age did not appear to be a significant predictor of psychological distress (p=0.738), as occurred in a Chinese study sample. 20 The study has certain limitations. First, the research is based on a crosssectional observational study. Therefore, there was no follow-up of individuals. Second, our sample does not reflect the national college students, since the objective was to evaluate the students from PUC/SP. Third, although there were responses from several undergraduate courses at the University, some of them presented a very small sample number, such as Communication and Multimedia (0.153%), Data Science and Artificial Intelligence (0.153%), Theology (0.306%), Philosophy (0.306%), when compared to other courses, such as Medicine (18.196%) . The study provides the first empirical evidence on the level of psychological distress in Brazilian university students during the Covid-19 pandemic. The results demonstrate a significant psychological disorder in the participants. Therefore, the study suggests support and monitoring of university students during and after the pandemic, with effective and efficient intervention in their mental health, such as (1) greater attention to vulnerable groups, such as women, non-medical interns and students of others courses that not Medicine; (2) University strategy, with planning . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 20, 2020. . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. Your anonymity will be guaranteed. The online system, chosen for the application of the questionnaire, does not allow us to identify the respondents to the questionnaire and any material that identifies their participation will be released without their authorization. If you still have doubts, you can be informed about any aspect of the study you want, before or after answering this questionnaire, through the researchers' contacts. We clarify that there will be no costs and no payment for those who participate in the study. We consider that there are no risks in participating in this research. At the end of the study, the researchers commit to communicating the results obtained with the research. The students will also participate in the project: . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 20, 2020. understood what was explained to me in this term, I agree to participate in the research project. Your acceptance to participate will be considered as your electronic signature of this informed consent form and the questionnaire link will only be available after your acceptance. . CC-BY-NC 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 20, 2020. . https://doi.org/10.1101/2020.06.19.20135251 doi: medRxiv preprint A Novel Coronavirus from Patients with Pneumonia in China WHO. Coronavirus disease (COVID-2019) situation reports Coronavirus confirmed as pandemic WHO. Novel Coronavirus-China Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review Municipal Health and Health Commission's Briefing on the Current Pneumonia Epidemic Situation in Our City 2019-nCoV epidemic: address mental health care to empower society Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. 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