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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 14  |  Issue : 2  |  Page : 239-244

Academic loss-related anxiety among college students during COVID-19 pandemic


1 MBBS Students, King George's Medical University, Lucknow, Uttar Pradesh, India
2 Department of Radiotherapy, King George's Medical University, Lucknow, Uttar Pradesh, India
3 Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
4 Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission20-Nov-2020
Date of Acceptance08-Apr-2021
Date of Web Publication31-May-2021

Correspondence Address:
Dr. Sujita Kumar Kar
Department of Psychiatry, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_398_20

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  Abstract 


BACKGROUND: The global outbreak of SARS-CoV2, initially affecting few individuals in Wuhan city of China, is now devastating millions of lives. Among all, students face substantial challenges, mainly in academic losses due to the imposed lockdown that may be detrimental to their mental well-being. Our study aimed to identify the anxiety levels among university students undergoing training in various disciplines.
METHODS: It was a cross-sectional study. General Anxiety Disorder-7 scale within a semi-structured questionnaire was used to assess students' anxiety levels about their academic loss.
RESULTS: A total of 507 students from India participated in the survey. Eventually, the prevalence of students experiencing anxiety was significantly high, and approximately 25% of the students reported moderate to severe anxiety levels. This emphasizes the need for psychological support to the students through various means to develop innovative solutions to handle the crisis.
CONCLUSION: Moreover, the lowest prevalence of anxiety among healthcare sciences students leads us to conclude that this population is well prepared mentally and hence should be the first choice of the future resort if the need arises to aid the current healthcare workforce.

Keywords: Academic loss, anxiety, COVID-19, lockdown, pandemic, students


How to cite this article:
Rai S, Akhtar Z, Singh KK, Bhatt ML, Verma SK, Kar SK. Academic loss-related anxiety among college students during COVID-19 pandemic. Indian J Health Sci Biomed Res 2021;14:239-44

How to cite this URL:
Rai S, Akhtar Z, Singh KK, Bhatt ML, Verma SK, Kar SK. Academic loss-related anxiety among college students during COVID-19 pandemic. Indian J Health Sci Biomed Res [serial online] 2021 [cited 2021 Jun 17];14:239-44. Available from: https://www.ijournalhs.org/text.asp?2021/14/2/239/317412




  Introduction Top


The coronavirus disease 2019 (COVID-19) pandemic is spreading rapidly across the globe. It has already taken under its effect more than 2.7 million people and has claimed more than 1.8 lakh lives in 213 countries and territories of the world as of April 25, 2020.[1] Countries worldwide face challenges to contain the spread of the causative virus-SARS-CoV-2.[2] As the pandemic is spreading its feet, it is challenging to keep the global population in a mentally sound state.[3] Though the infection and fatality rate may be significant causes of depression, anxiety, and stress among the population, a further matter of concern is the mental health issues posed due to stringent measures taken by governments worldwide.[4] For instance, a significant section of the globe, including India, is under complete lockdown due to the pandemic, thus restricting people's social interactions, leading to mental distress.[4],[5]

Moreover, on a broader level, the lockdown affects the affected countries' economy and education systems. All the schools and colleges across the affected nations have been shut down to limit the disease's spread. The academic fraternity has nearly shattered with such a large-scale shutdown of schools and colleges.[6] According to UNESCO, the nationwide closures impact over 90% of the world's student population.[7] Students face a wide range of issues during college shut-downs besides the pandemic's growing ugly face. Delayed timelines of academic activities, lagging behind syllabus, and the uncertainly postponed ongoing and upcoming exams, results, and uncertainty over job recruitments are significant concerns for the students.[5] Although many colleges have shifted their teaching model, it comes with another set of difficulties, such as poor internet connection in suburban areas. Medical education, specifically, is deeply suffering as the students are not getting the clinical exposure, which is a part of their regular training. This can have a detrimental effect on their examination performance and competency as future clinicians.[8] These may further lead to anxieties in medical students.

Wenjun et al. emphasize the significance of monitoring college students' mental health during such outbreaks.[9] However, watching the anxieties of especially the medical students at this time of the pandemic is of utmost importance. This is the population of the future resort in case the pandemic worsens in the coming days. Suppose the healthcare workforce planners in India decide to recruit medical students for essential services. In that case, they will be responsible for training them for the same both physically and mentally. Healthcare workforce planners across many countries are attempting to put medical students with the clinicians on the front line to cope with workforce shortages.[10],[11],[12] And not only in the frontline in the case of shortages, but medical students may also play other crucial roles as well to provide essential services during the pandemic. They can aid in outpatient care to the best of their abilities to compensate for the clinicians engaged in the pandemic.[13] As the pandemic worsens in India with almost the entire healthcare fraternity except for the students already involved, India may also need to recruit the medical students in the workforce in the foreseeable future.

Not just medical students, we may need the assistance of students from all the disciplines for an overall relief from the pandemic. In that situation, as future leaders, students from all fields will have to come up with more technical ideas for advancements in healthcare to cope with the pandemic and more innovative plans to save the country; s declining economy. They may also reveal surprising insights to deal more effectively with such pandemics if they re-occur in the future. And finally, it is the responsibility of the all the students of the country, who have more access to the internet and technology to disseminate authentic information and educate people to prevent them from panicking during this challenging time. It is thus crucial for the country's student population that they remain mentally sound and be more prepared rather than anxious for the future.

However, in India, data are lacking that can tell us about the influence of the global outbreak of COVID-19 on students' mental health. As the lockdown state is extending in the country and the pandemic is running for a more extended period, it is expected that the students' academic loss will be impactful. Therefore, we aimed to assess students' anxiety levels related to various disciplines' academics during the COVID-19 pandemic. We also aimed to estimate the difference in anxiety levels based on their socio-demographic characteristics.


  Methods Top


This was a descriptive, cross-sectional, and a questionnaire-based study conducted in a community setting involving students studying in different college courses across India during the COVID-19 pandemic. Institutional ethics committee approval was taken. Data collection was done after the COVID-19 lockdown. Students studying in various colleges of India and providing consent to participate were included in the study. Participants were recruited through purposive sampling. As the questionnaire was developed in English, only those comfortable in English participated in the study. Those students who had provided incomplete data were excluded from the analysis.

Data was collected through an online questionnaire created by using “google forms.” The questionnaire was divided into three parts. Consent to participate was asked for in the 1st part. The 2nd part had questions on socio-demographic data, including age, sex, and current study year. The last part of the questionnaire included the Generalised Anxiety Disorder-7 (GAD-7) scale to assess participants' anxiety levels. The students were asked to respond to the anxiety-related questionnaire, considering the academic loss due to COVID-19 pandemic. Due to a lack of tools that measure anxiety concerning the academic loss, we rephrased the GAD-7 questionnaires giving the reference of academic loss in the context of COVID-19.

After developing the online questionnaire, a link to access was generated and shared among students through social media platforms such as WhatsApp and Facebook. Informed consent was taken in the online form before participation in the survey from each participant, and the confidentiality of obtained data was maintained. The questionnaire took an average of 10 min for completion. Participation in the study was completely voluntary.

A GAD-7 scale is a tool developed for screening and measuring the severity of GAD.[14] It consists of 7-items on the scale that assesses the frequency of anxiety symptoms in subjects over the past 2 weeks. Each item has to be rated on a 4-point scale ranging from 0-”not at all” to 3-”almost every day.” Eventually, the ratings of all items are added to obtain the anxiety score for each individual. The maximum score obtained using it is 21, while the minimum score possible is 0. A score between 4 and 9 suggests mild anxiety level; 10–14 suggests moderate; above 15 suggests severe anxiety. Though the GAD-7 scale was developed for screening of GAD, it is now a widely used and reliable tool for measuring anxiety in the general population.

The participants were divided into the following three groups based on their discipline of study: Group A: Students of health sciences subjects (e.g., MBBS, BDS, BAMS, etc.), Group B: Engineering students and Group C: College students of other disciplines. The mean GAD scores of these groups were then compared using a one-way analysis of variance (ANOVA) test.

To examine the age-based differences in anxiety scores, participants were again divided into two groups: Group 1 with the age of 20 or fewer years and Group 2 having individuals with an age of more than 20 years. Similarly, based on gender, participants were divided into two groups-females and males. The mean GAD scores were then compared between these groups.

The collected data were analyzed using the SPSS version 26 software (IBM Corp. IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp.). Descriptive statistics were used to summarize the findings. ANOVA test was used to compare the mean GAD scores of three groups classified base on their disciplines. To demonstrate gender-based and age-based differences in GAD scores between groups, we used Student's t-test. A Chi-square test was used to compare the severity of anxiety across various disciplines and gender.

Ethical clearance

The study was approved by the institutional ethics committee of KGMU, with reference number 101st ECM IB/P2.


  Results Top


We obtained 515 responses from students studying in different courses across the country. Eventually, 507 students provided consent for participation in the survey (with a response rate of 98.4%), thus, included in the study. [Table 1] shows the demographics of the participating students. Out of all students who participated in the survey, 167 (32.94%) were females, and 340 (67.06%) were males. The mean age of participants was 21 ± 1.789 years. Among them, 398 (78.5%) students were from healthcare institutions (Group A), 78 students (15.4%) were from the engineering discipline (Group B), and 31 students (6.1%) from other fields were included under Group C. Most of the participants (90.92%) were from the Northern states of India, and the rest were from Eastern states (4.93%), Central and Southern states (4.14%).
Table 1: Comparison of the anxiety scores of participants according to sociodemographic characteristics

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[Table 1] shows the anxiety score (as measured by GAD 7) of participants based on their socio-demographic characteristics. All participants' anxiety scores (n = 507) ranged from 0 to 21, with a mean score of 6.53 ± 5.07. The students from healthcare institutions, i.e., Group A (n = 398), had a mean anxiety score of 6.08 ± 4.74, and Group B students (n = 78) from technical institutes had a mean anxiety score of 7.55 ± 5.67. In contrast, Group C (n = 31) had a mean anxiety score of 9.65 ± 6.10. ANOVA revealed a significant difference in anxiety scores among these groups (P < 0.05).

Chi-square test revealed a significant difference in the severity levels of anxiety between medical graduates, technical graduates, and other streams graduates, with a Chi-square value of 27.824 and a P < 0.05 [Table 2]. In the healthcare disciplines in the Group-A students, 5.78% of students had severe anxiety, while 12.82% of Group B students had severe anxiety. 43.21% of students of group A while 33.33% of students of group B had minimal anxiety.
Table 2: Comparison of the anxiety severity among students of various disciplines

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The mean anxiety score of males (n = 340) was 6.45 ± 5.16, and females (n = 167) were 6.69 ± 4.88. Student's t-test revealed no significant difference in anxiety scores of these two groups (P > 0.05). We also assessed the anxiety scores of two groups classified based on their ages. The group with all individuals having aged in the range of 17–20 years (n = 220) had a mean anxiety score of 6.11 ± 4.98 while another group with all individuals having ages more than 20 years (n = 285) had a mean anxiety score of 6.87 ± 5.13. The difference in the level of anxiety based on age was not statistically significant (P = 0.095).

To examine whether students' anxiety was associated with the next upcoming examination duration, we divided students into four groups [Table 1]. We observed that students who had their examinations scheduled within 1 month had the highest anxiety levels (8.28 ± 5.86). Students who had their exams after 6 months were having the lowest anxiety (5.75 ± 5.02). The difference in the mean anxiety between these four groups was found to be significant, P < 0.05. There was a substantial difference in the severity levels of anxiety between healthcare graduates (MBBS/BDS/BAMS), technical graduates (B Tech), and general stream graduates [Table 2].


  Discussion Top


Our study found that 59% of the college students across various disciplines experienced a varying level of anxiety during the COVID-19 pandemic, i.e., these participants had GAD scores >4. The high prevalence of stress among college students during this pandemic is consistent with the prevalence during the previous pandemics of SARS and H1N1. For instance, in a study conducted by Sheri et al. on Canadian university students during the 2003 SARS outbreak, 53% reported having high anxieties.[15] In a study conducted by Kanadiya et al. on American college students during the 2009 H1N1 swine flu outbreak, 83.1% reported having various anxiety.[16] In our study, 34.3% of the college students experienced mild anxiety, 16.4% experienced moderate anxiety, and 8.3% experienced severe anxiety. These measures are higher than those found by Cao et al. in their recent study on Chinese college students using the same scale, where 21.3% of the participants experienced mild anxiety, 2.7% experienced moderate anxiety, whereas 0.9% experienced severe anxiety during the COVID-19 pandemic.[9] It might be due to the difference in the level of awareness about COVID-19 and preparedness to face the pandemic in the study population of Cao et al. and our study. As the pandemic started in China, Chinese students are expected to be more aware of the disease than the rest of the world. Cao et al. also found a delay in students' academics to be positively correlated with their anxieties.[9] Furthermore, Gautam et al. discussed that factors such as uncertainty about upcoming exams, results, delay in internships, delay in job recruitments, and financial losses due to the ongoing nationwide lockdowns lead to students' anxieties during the times of pandemic.[6] Similar factors may also be responsible for the anxiety of students reported in our study.

A study on the general population by the Chinese psychology society during the COVID-19 pandemic found symptoms of anxiety in 42.6% out of a total of 18,000 people screened.[17] Another study by Wang et al. on the general population found 28.8% moderate-to-severe anxiety prevalence using the Depression, Anxiety, and Stress Scale-21during COVID-19 Pandemic.[18] However, the combined prevalence of students with moderate and severe anxieties in our study was 25%. This suggests that fewer students were having moderate to severe anxiety during the pandemic than the general population. In their research on the general public, Huang et al. found that 35.1% of the participants had GAD-7 scale scores >9.[19] While in our study, 30.6% of the participants had GAD-7 scores >9. The apparent lower anxieties in college students than the general population may be due to higher awareness about the pandemic.

We also found a significant difference in the mean anxiety scores between three groups of college students who participated in our study. Out of the three groups - healthcare sciences students, engineering students, and other general stream students, we found the anxiety levels to be lower in the healthcare science students (mean GAD-7 score-6.08 ± 4.74) as compared to other groups (engineering students' mean GAD-7 score was7.55 ± 5.67 while other streams students' mean GAD-7 score was 9.65 ± 6.10). Surprisingly, a study during prepandemic times found anxieties to be significantly higher in medical students as compared to engineering students (medical students' mean anxiety score was 43.18 + 10.561 and engineering students' mean score was 33.78 + 9.743 on Sinha's comprehensive anxiety test, which has a maximum possible score of 90 and a minimum possible score of 0 and higher scores indicate more anxiety).[20] The reason they provided for higher anxiety among medical students was long working hours and interaction with severely ill patients, as seen with the medical students.[20] Notably, these factors do not hold during the pandemic due to closures of medical colleges, which indicate us toward a different set of reasons. Moreover, lower anxieties in healthcare science students than other streams during pandemic times may be a positive sign for the healthcare workforce planners planning to recruit medical students in the workforce if the need arises.

To examine the factors influencing students' anxiety, we further investigated and found a significant difference in mean anxiety scores between the groups divided based on the time duration left from the next examination. The group expects their subsequent examination within 1 month was found to have a higher mean anxiety. These findings are prominent and suggest that college students might need psychological support to overcome their anxieties over the uncertainties.

When comparing the males and females, we found no significant difference in their anxieties. This contrasts with the findings of earlier studies that found females to be more anxious than males.[21],[22]

In a nutshell, the lowest level of anxiety among healthcare sciences students leads us to conclude that this group may prove to be the most appropriate to provide essential services in the future if needed. A meager population of students across the world is already recognizing the crucial roles they can play during this pandemic and are coming up with quite innovative solutions for the problems while some medical students are expressing their willingness to work in the frontlines against the pandemic.[23],[24] It is similarly crucial that every student recognizes his/her responsibility in fighting this pandemic. But for that to happen, the sound mental health of the student population needs to be ensured. This can be done by preventing their academic losses by providing them online lectures and other content, as already implemented in China.[25] Although this has already been achieved in many colleges across India, it comes with another set of challenges, such as poor internet connections and failure to access the content. Such problems should also be addressed to the best, in favor of students. To mitigate the anxiety among students, there is a need to address all possible anxiety factors. Improving awareness through e-learning platforms, strengthening the online educational platforms, and providing mental health supports (through online consultation and counseling) may help to meet the academic challenges effectively.

Limitations

The number of students from the general discipline (Group C) and engineering discipline (Group B) was small. Group C incorporated multiple nontechnical disciplines; so, the differences are wide. Further studies should attempt it in a larger population. Anxiety is a dynamic phenomenon. As the pandemic progresses, anxiety is likely to change (either increase due to the amount of academic loss or decrease due to acceptance and coping with the situation). Hence, a prospective study design will be useful to measure the changing pattern of anxiety among students. Being a cross-sectional study, our study cannot give insight into the changing patterns of anxiety.

Similarly, various other factors may attribute to anxiety, and it is difficult to differentiate the anxiety due to other reasons from anxiety due to academic loss. It can be a potential bias in this study. However, we made our best effort by rephrasing the anxiety-related questions by adding the contexts (academic loss and COVID-19).


  Conclusion Top


Academic loss due to lockdown during this COVID-19 pandemic is anxiety-provoking among the college students of various disciplines. Students of the general stream experience more anxiety than the professional graduates, due to academic loss. There is a need to address the mental health issues of students who experience anxiety due to academic loss as well as facilitate the process of e-learning to compensate for classroom teaching.

Ethical approval

The data collection team of investigators had ensured the confidentiality of the participants. We had followed the “Declaration of Helsinki”– ethical principles for medical research involving human subjects. Reference code: 101st ECM IB/P2.

Informed consent

All participants provided informed consent online.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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[PUBMED]  [Full text]  
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