key: cord-0796206-uyg4bs16
authors: Swai, Joel; Mohamed, Adam; Zhang, Jing-ping
title: Commentary: Impact of the COVID-19 Pandemic on the Mental Health of College Students: A Systematic Review and Meta-Analysis
date: 2021-11-16
journal: Front Psychol
DOI: 10.3389/fpsyg.2021.753798
sha: 7fb12ec4173a8dc3436f65d88437246862be7823
doc_id: 796206
cord_uid: uyg4bs16

nan

Coronavirus Disease 2019 pandemic has resulted in adverse psychological effects among individuals globally. Recurring infection waves, extended lockdowns, the emergence of more transmissible, and immunity evasive variants are among the unpredictable factors that lead to an increased sense of fear associated with the pandemic (Batista et al., 2021) . Moreover, social isolation, quarantines, unemployment, and long-covid are strongly associated with depression (Loades et al., 2020; Islam et al., 2021) . These issues indicate the need for epidemiological studies exploring the pandemic's effect on mental health.

In a recent meta-analysis study by Li et al. (2021) , the authors pooled the prevalence of anxiety and depression associated with COVID-19 among college students. They reported a prevalence of 36% [95% Confidence Interval (CI): 26-46] and 39% [CI: 27-51] for anxiety and depression, respectively, both with statistically significant high heterogeneity of 99.9%, p < 0.01. In their study limitations section, authors called upon further heterogeneity analyses by considering the confounding factors. In response, we performed a meta-regression and pooled the prevalence of anxiety and depression stratifying results by potential confounders (i.e., gender, survey instrument used, survey country, and survey dates).

Figures 1A-D summarizes the meta-regression of pooled proportions (Proportion = prevalence/100%) of anxiety stratified by survey date, survey instrument, survey country, and male-female ratio. The prevalence of anxiety was statistically significant higher in studies conducted after March the first [beta = 2.68; standard error (SE) = 0.67, t = 3.95, p = 0.001; CI: 1.58-4.55]. There was no statistically significant difference in the prevalence among studies using Moreover, the prevalence of anxiety in Asian (i.e., Bangladesh, China, and Jordan) countries were lower as compared to European (i.e., Spain, Switzerland) and America [beta = 1.27; SE = 0.08, t = 3.86, p = 0.001; CI: 1.11-1.44]. Interestingly, studies with more males than females (i.e., male: female >1) had higher prevalence of anxiety than studies with more females than males (i.e., male; females <1) [beta = 0.26; SE = 0.09, t = 3.69, p = 0.002; CI: 0.12-0.56].

Having identified the confounders, we, therefore, pooled the overall prevalence of anxiety only including studies (Jiang et al., 2020; Liu et al., 2020; Wang and Zhao, 2020) conducted in the same country (i.e., China), on the same survey dates (i.e., before the first of March), and having the same male-female ratio (i.e., 0.7). The overall proportion was 0.15 [CI: 0.14-0.16] (i.e., prevalence = 15%) with non-significant heterogeneity (I 2 ) of 63.8%, p = 0.063. There was no sufficient data to conduct this analysis in other countries. Figures 1E-H illustrates the meta-regression of pooled prevalence of depression stratified by survey date, survey instrument, survey country, and male-female ratio. Studies conducted after the first of March had a higher pooled prevalence of depression than before [beta = 2.48; SE We pooled the overall prevalence of depression only including studies (Chang et al., 2020; Chi et al., 2020) conducted in the same country (i.e., China), on the same survey dates (i.e., before the first of March), having the same male-female ratio (i.e., 0.6) and used same survey instrument (i.e., PHQ-9). The overall proportion was 0.22 [CI: 0.20-0.24] (i.e., prevalence = 22%) with non-significant heterogeneity (I 2 ) of 66.80%, p = 0.083. Other countries had no sufficient data to conduct this analysis.

The differences in the college students' prevalence of depression and anxiety among nations and study survey dates, reported by Li et al., are statistically significant (i.e., p < 0.05). However, the prevalence of anxiety and depression are 15 and 22%, respectively, instead of 36 and 39% reported by Li et al. In addition, studies with more males than females had a statistically significant higher prevalence of anxiety and depression than studies with more females than males.

Anxiety impact during COVID-19: a systematic review

Prevalence and psychosocial correlates of mental health outcomes among Chinese college students during the coronavirus disease (COVID-19) pandemic. Front

Treatment, persistent symptoms, and depression in people infected with COVID-19 in Bangladesh

Analysis of mental health status and influencing factors of preventive medicine students in a university during the outbreak of new coronavirus pneumonia

Impact of the COVID-19 pandemic on the mental health of college students: a systematic review and meta-analysis

Online mental health survey in a medical college in china during the COVID-19 outbreak. Front

Rapid systematic review: the impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19

The impact of COVID-19 on anxiety in Chinese university students

Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.