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The Covid-19 pandemic: a traumatic event for health and biological science students?

Abstract:

Introduction:

Health Sciences university students were especially affected by the Sars-CoV-2 virus pandemic. The anxieties intrinsically related to Covid-19 were added to the impacts related to the changes that have taken place in academic institutions, particularly the change to online teaching, a methodology that can generate discomfort for students, in addition to several obstacles related to teaching and learning, which can have important traumatic effects on the mental health of this population.

Objective:

To assess the mental health burden caused by the COVID-19 pandemic, as a traumatic event capable of triggering psychiatric disorders, such as Post-Traumatic Stress Disorder (PTSD), in university students.

Methods:

This is a cross-sectional and quantitative study, of analytical-descriptive nature, carried out by filling out an anonymous digital form, initiated after prior approval by the Research Ethics Committee. The subjects were students of Biological and Health Sciences at a State University located in the southeastern region of Brazil. The sample consisted of 618 students.

Results:

618 forms were answered by students attending the courses of Physical Education (28.8%), Medicine (25.4%), Dentistry (18.1%), Biological Sciences (15.2%) and Nursing (12.5%). The presence of post-traumatic stress symptoms assessed by the Impact of Event Scale - Revised (IES-R) obtained a prevalence of 32.7% (n = 202) among university students from Biological and Health Sciences courses.

Conclusions:

There was a significant impact on the mental health of university students, with the presence of depressive symptoms, anxiety and stress above those found in the scientific literature and, consequently, a high prevalence of PTSD.

Keywords:
Students, Health Occupations; Covid-19; Stress Disorders, Post-Traumatic

Resumo:

Introdução:

Os universitários de Ciências da Saúde se tornaram especialmente afetados pela pandemia do vírus Sars-CoV-2. As angústias intrinsicamente relacionadas à Covid-19 foram somadas aos impactos referentes às mudanças acontecidas nas instituições acadêmicas, particularmente a mudança para o ensino on-line, uma metodologia que pode gerar desconforto aos estudantes, além de vários obstáculos relacionados ao ensino e à aprendizagem, o que pode ter repercussões traumáticas importantes na saúde mental dessa população.

Objetivo:

Este estudo teve como objetivo verificar a carga mental provocada pela pandemia da Covid-19, como um evento traumático ao ponto de desencadear transtornos psiquiátricos, como o transtorno do estresse pós-traumático (Tept), em universitários.

Método:

Trata-se de um estudo transversal e quantitativo, com orientação analítico-descritiva, mediante preenchimento de formulário digital anônimo, iniciado após prévia aprovação do Comitê de Ética em Pesquisa. Os sujeitos foram estudantes de Ciências Biológicas e da Saúde de uma universidade estadual localizada na Região Sudeste do Brasil. A amostra foi constituída por 618 estudantes.

Resultado:

Foram respondidos 618 formulários pelos estudantes que pertenciam aos cursos de Educação Física (28,8%), Medicina (25,4%), Odontologia (18,1%), Ciências Biológicas (15,2%) e Enfermagem (12,5%). A presença de sintomas de estresse pós-traumático verificados pela Escala de Impacto do Evento-Revisada (IES-R) obteve prevalência de 32,7% (n = 202) entre os estudantes universitários das Ciências Biológicas e da Saúde.

Conclusão:

Houve impacto significativo na saúde mental dos universitários com presença de sintomas depressivos, ansiedade e estresse acima dos encontrados na literatura científica, e, consequentemente, constatou-se alta na prevalência do Tept.

Palavras-chave:
Estudantes de Ciências da Saúde; Covid-19; Transtornos de Estresse Pós-Traumáticos

INTRODUCTION

At the end of 2019, Covid-19 gained worldwide visibility due to its action in the province of Wuhan, China. In an abrupt and accelerated way, it spread globally, thus gaining the status of a pandemic and, consequently, affecting people’s normal lives due to its devastating effects11. Mamun F al, Hosen I, Misti JM, Kaggwa MM, Mamun MA. Mental disorders of Bangladeshi students during the Covid-19 pandemic: a systematic review. Psychol Res Behav Manag. 2021 May 31;14:645-54., causing worldwide changes at personal, professional and social levels22. Meleiro AMAS, Danila AH, Humes EC, Baldassin SP, Silva AG da, Oliva-Costa EF de. Adoecimento mental dos médicos na pandemia do Covid-19. Debates em Psiquiatria. 2021;11:1-20.. The need to face all these levels, the fear of the unknown, the risk of transmitting the virus to family members, the health system overload, and the experience of mourning were established as new problems that impacted people’s mental health33. Acioli DMN, Santos AAP, Santos JAM, Souza IP de, Silva RKL. Impactos da Covid-19 para enfermeiros. Rev Eenferm UERJ. 2022;30:e63904. doi: http://dx.doi.org/10.12957/reuerj.2022.63904.
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Moreover, sanitary measures were taken to mitigate contamination, particularly, the use of face masks and social distancing44. Maciel E, Fernandez M, Calife K, Garrett D, Domingues C, Kerr L, et al. A campanha de vacinação contra o Sars-CoV-2 no Brasil e a invisibilidade das evidências científicas. Cien Saude Colet. 2022;27:951-6.. Therefore, several issues emerged as a reflection of these measures, such as conflicting social life, financial problems, difficulty in practicing physical exercises, increased stress and reduced sleep quality55. Bezerra ACV, Silva CEM da, Soares FRG, Silva JAM da. Fatores associados ao comportamento da população durante o isolamento social na pandemia de Covid-19. Cien Saude Colet . 2020;25(supl 1):2411-21.. In view of its severity, the Covid-19 pandemic became the greatest challenge faced after the Second World War, with more than 230 million people infected worldwide, around 5 million deaths, in addition to generating social and economic calamity, such as 205 million unemployed individuals in 202266. International Labour Office. World Employment and Social Outlook: Trends 2021. Geneva: ILO; 2021. Disponível em: https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/---publ/documents/publication/wcms_795453.pdf
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. The psychological stress experienced in this context affected healthy individuals, causing fear and stress, and intensified these symptoms in those with pre-existing psychiatric disorders, which could lead to chaos in personal and family life77. S.M. Didar-Ul Islam, Md. Bodrud-Doza, Rafid Mahmud Khan, Md. Abidul Haque, Mohammed A. Mamun. Exploring Covid-19 stress and its factors in Bangladesh: a perception-based study. Heliyon. 2020 July;6(7):e04399..

However, aiming to follow one’s life projects, the pandemic has become an important moment for changes in personal lifestyles, in family, economic and educational contexts88. Fagundes AT, Willrich JQ, Antonacci MH, Kantorski LP, Portela DL, Souza TT. Universitários no contexto da Covid-19: perfil, comportamentos e atividades acadêmicas. Cogitare Enferm. 2022;27 Disponível em: http://dx.doi.org/10.5380/ce.v27i0.82306.
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),(99. Bezerra CB, Saintrain MVL, Braga DBA, Santos FS, Lima AOP, Brito EHS de, et al. Impacto psicossocial do isolamento durante pandemia de Covid-19 na população brasileira: análise transversal preliminar. Saúde Soc. 2020;29(4): 1-10 [acesso em 5 abr 2021]. Disponível em: Disponível em: https://doi.org/10.1590/S0104-12902020200412 .
https://doi.org/10.1590/S0104-1290202020...
. Society had to reorganize itself and face the current reality and more challenges were imposed on schools and universities, which had to adapt their teaching format, migrating from the in-person to the remote teaching model1010. Maia BR, Dias PC. Ansiedade, depressão e estresse em estudantes universitários: o impacto da Covid-19. Estud Psicol. 2020;37: 1-8. doi: https://doi.org/10.1590/1982-0275202037e200067.
https://doi.org/10.1590/1982-0275202037e...
, changing both teaching and learning and social interaction and communication. Online teaching brought some discomfort to a large number of students, such as those with difficulties related to internet access, in addition to apathy in attending classes, which can lead to problems with attendance and participation in virtual classes1111. Nambiar D. The impact of online learning during Covid-19: students’ and teachers’ perspective. International Journal of Indian Psychology. 2020 June 25;8(2). Disponível em: https://doi.org/2010.25215/0802.094.
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The existence of obstacles faced by some students in the pandemic has become evident. And the quality of life of University students may have been negatively impacted by mental suffering caused by social and economic interruptions, uncertainty about their future careers, loneliness and fear of losing loved ones1212. Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM, et al. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Brazilian J Psychiatry. 2017 Dec 1º;39(4):369-78.. A previous study11. Mamun F al, Hosen I, Misti JM, Kaggwa MM, Mamun MA. Mental disorders of Bangladeshi students during the Covid-19 pandemic: a systematic review. Psychol Res Behav Manag. 2021 May 31;14:645-54. showed important changes in mental health among the general population around the world, with high rates in the results, describing a prevalence of up to 50.9% for anxiety, 48.3% for depression, 53.8% for post-traumatic stress disorder, 38% for psychological distress and 81.9% for stress. In view of this, this period can become a traumatic event and develop into Post-Traumatic Stress Disorder (PTSD), and put one’s own life at risk, since it is negatively linked to suicidal ideation.

PTSD is a type of anxiety disorder that encompasses emotional and psychic symptoms, and may have physical manifestations, caused by a traumatic event. According to the Diagnostic and Statistical Manual of Mental Disorders1313. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington: APA; 2013., it can be defined as a function of exposure to a concrete episode or threat of death, serious injury or sexual violation. The individual may directly experience the traumatic event, witness it personally when it occurs to others, discover its occurrence from a family member or close friend, or be repeatedly or extremely exposed to aversive details of the event.

PTSD is a prevalent and disabling psychiatric disorder that, according to the World Health Organization (WHO), affects two million people in Brazil. It is well known that several diseases and disorders can increase the risk of emotional problems in an individual. However, a traumatic event can also affect one’s mental health, since the risk of developing PTSD can reach 15% of the general population1414. Luz MP, Coutinho ESF, Berger W, Mendlowicz MV, Vilete LMP, Mello MF, et al. Conditional risk for posttraumatic stress disorder in an epidemiological study of a Brazilian urban population. J Psychiatr Res. 2016 Jan;72:51-7.. Bo H-X et al. (2020) showed that most evaluated people with COVID-19 experienced both physical suffering and great psychological suffering, with PTSD symptoms being present in 96.2% of them1515. Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with Covid-19 in China. Psychol Med. 2021 Apr;51(6):1052-3.

Therefore, this study aimed to assess the mental burden caused by the COVID-19 pandemic, caused by the new coronavirus, SARS-CoV-2, as a traumatic event to the point of triggering psychiatric disorders, such as PTSD and favoring the development of mental disorders among University students.

METHOD

Study type

This is a cross-sectional, quantitative study, carried out between September 10, 2020 and January 4, 2021, in which the investigated dependent variable was the presence of symptoms related to post-traumatic stress mediated by the psychological effect caused by the SARS-CoV-2 pandemic.

Population and Sample

The target population consisted of students from the Center of Biological and Health Sciences (CCBS, Centro de Ciências Biológicas e da Saúde) of a university located in the Southeast region of Brazil. There were 1,912 students enrolled in at least one of five courses: Biological Sciences (406), Physical Education (639), Nursing (204), Medicine (426), and Dentistry (237). All students were invited to participate in the study; however, the sample was defined by means of sample calculation for finite populations, considering the prevalence of the event of interest at 30%, confidence level of 95%, margin of error of 3%, design effect (Deff) = 2 and considering the proportionality of participation of students from all courses. The minimum sample size calculated was 611 students, with the study sample consisting of 618 students, a number greater than the minimum required in the sample calculation.

Data collection

Data were collected using a self-administered digital form, created on Google Forms platform (Google LLC, Menlo Park, CA, USA) and sent directly to the email of each class of the CCBS courses. The form was disseminated during lectures in all classes and on social networks - Instagram and WhatsApp - aiming to encourage greater student participation.

In addition, course and semester coordinators, as well as teachers and students representing classes, were invited, via email and WhatsApp, to disseminate the research among university students and, thus, create opportunities for greater awareness of the study importance. A partnership was also established with the Athletic Associations and Academic Centers of the CCBS courses to disseminate the research and raise awareness about its adherence.

The form was anonymous and organized into sections, according to topics of interest. Validated questionnaires were used for data collection, such as the Impact of Event Scale - Revised (IES-R), the Patient Health Questionnaire 9 (PHQ-9), the Depression, Anxiety and Stress Scale 21 (DASS-21) and items from the ‘Fantastic Lifestyle’ questionnaire were used for the collection of sociodemographic data, questions related to the students’ characteristics, such as gender, age, skin color/ethnicity, sexual orientation, presence of special needs and chronic diseases, marital status, enrolled course, satisfaction with the remote teaching model implemented by the university during the pandemic, as well as self-perception of academic overload due to activities during the pandemic, whether the student lived alone, whether the student had a paid work and family income before the pandemic.

Symptoms of post-traumatic stress caused by the pandemic were assessed using the IES-R instrument, validated in Brazil1616. Caiuby AVS, Lacerda SS, Quintana MI, Tori TS, Andreoli SB. Adaptação transcultural da versão brasileira da Escala do Impacto do Evento-Revisada (IES-R). Cad Saude Publica. 2012;28(3):597-603.. The IES-R is a scale consisting of 22 items, with a score ranging from 0 to 4 points, related to the presence, in the last 7 days, of the diagnostic criteria for PTSD established by the DSM-IV1717. American Psychiatric Association. Manual diagnóstico e estatístico de transtornos mentais: DSM-IV (TR). Porto Alegre: Artes Médicas; 2002.. The IES-R is divided into 3 subscales: avoidance, intrusion and hyperstimulation. The instrument final score is calculated by adding the average of the subscales and the cutoff point adopted for the presence of PTSD was 5.6 points1616. Caiuby AVS, Lacerda SS, Quintana MI, Tori TS, Andreoli SB. Adaptação transcultural da versão brasileira da Escala do Impacto do Evento-Revisada (IES-R). Cad Saude Publica. 2012;28(3):597-603..

Some items from the ‘Fantastic Lifestyle’ questionnaire1818. Añez CRR, Reis RS, Petroski EL. Versão brasileira do questionário “Estilo de Vida Fantástico”: tradução e validação para adultos jovens. Arq Bras Cardiol. 2008;91(2):102-9. were used to verify the practice of weekly vigorous and moderate physical activity, alcohol and tobacco consumption in the last 30 days, as well as the use of illicit drugs (such as marijuana and cocaine) during the pandemic.

The PHQ-9 was used to assess the presence of depressive symptoms. The PHQ-9 has ten items, of which the first nine are scored from 0 (“none of the days”) to 3 (“almost every day”), according to the number of days the symptoms were present in the last two weeks1919. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-13.. The tenth item of the questionnaire assesses the degree of functional impairment caused by the symptoms to perform activities, ranging from “no difficulty” to “extreme difficulty”. Based on the instrument score, obtained by adding the points of the first 9 questions, the severity of the depressive symptoms can be classified as: none/minimal (0 to 4 points), mild depression (5 to 9), moderate depression (10 to 14), moderately severe depression (15 to 19) and severe depression (20 to 27).

Symptoms of anxiety and stress were verified through DASS-212020. Vignola RC, Tucci AM. Adaptation and validation of the Depression, Anxiety and Stress Scale (DASS) to Brazilian Portuguese. J Affect Disord. 2014 Feb;155:104-9.. This is a self-report scale consisting of 21 items graded from 0 (totally disagree) to 3 (totally agree), which assesses how the individual felt in the previous week. The DASS-21 instrument is divided into subscales for depression, anxiety and stress and the score of each subscale is calculated separately, allowing classifying the symptom levels into normal, mild, moderate, severe and very severe2020. Vignola RC, Tucci AM. Adaptation and validation of the Depression, Anxiety and Stress Scale (DASS) to Brazilian Portuguese. J Affect Disord. 2014 Feb;155:104-9..

Other evaluated factors were: self-perception of health: (poor to very good); religiosity - through the question: “To what extent do you consider yourself a religious person?”, with answers ranging from “very religious” to “not at all religious”; thoughts about suicide (“in the past 12 months, have you ever seriously thought about committing suicide?”).

The questions related to the COVID-19 pandemic were: infection and positive diagnosis for COVID-19; death of a relative or close friend due to complications from Covid-19 and presence of flu-like symptoms during the pandemic such as fever, chills, headache, productive cough, dyspnea, fatigue or tiredness, sore throat, rhinorrhea, nasal congestion, nausea or vomiting, diarrhea, arthralgia, myalgia and anosmia or dysgeusia. It was also verified whether any student needed hospitalization due to Covid-19 or lived with an individual considered to be at risk for Covid-19.

Inclusion criteria were: being enrolled in the institution, regularly attending the course and being 18 years of age or older. The exclusion criteria comprised students who did not comply with the Free and Informed Consent Form (FICF) and did not agree to participate in the research.

Statistical analysis

For data analysis, the Statistical Package for Social Sciences (SPSS®) software, version 22.0 was used. The simple and relative frequencies of the dependent and independent variables were presented, as well as the association of the independent variables in relation to the presence of post-traumatic stress symptoms. Bivariate analyses were performed using Poisson Regression, presenting crude Prevalence Ratio (PR), 95% Confidence Interval (95%CI) and p-value. The independent variables with a p-value ≤ 0.20 in the bivariate analysis were selected to initially constitute the multiple model through Poisson Regression, with robust variance. The variables were removed one by one until only the variables associated at the 5% level remained in the final model. The magnitude of the multiple model associations was estimated by the adjusted PR, 95%CI and p-value ≤ 0.05, and the presence of post-traumatic stress disorder was the category to be tested. Model quality was assessed using the Deviance test.

Ethical Considerations

All research participants were informed about the methodological procedure and invited to carefully read the Free and Informed Consent Form, available digitally. The research project was approved by the Research Ethics Committee under the Presentation Certificate for Ethical Appreciation (CAAE, Certificado de Apresentação para Apreciação Ética) n. 25716019.1.0000.5146 and Approval Opinion number 3.724.553 of November 25, 2019. Therefore, the present study is supported by ethical precepts and these were duly followed, guaranteeing the voluntary participation, the anonymity of the participants’ responses and the confidentiality of the collected data. All participants agreed to participate in the research by agreeing with the digitally informed FICF.

RESULTS

A total of 618 forms were answered by students who were enrolled in the Physical Education (28.8%), Medicine (25.4%), Dentistry (18.1%), Biological Sciences (15.2%) and Nursing (12.5%) courses. There was a predominance of females among the participants, aged between 21 and 25 years, non-white, heterosexual orientation, without special needs or chronic diseases and single. Table 1 shows the participants’ characteristics through the descriptive analysis of sociodemographic and independent variables that were analyzed.

Table 1
Characterization of participants and descriptive analysis of the sample. 2020 (n = 618).

Regarding the COVID-19 pandemic, the absence of diagnosis for SARS-CoV-2 infection predominated, as well as the absence of death of relatives and friends due to complications caused by COVID-19. On the other hand, most participants reported having flu-like symptoms during the period and living with people from a risk group. Regarding hospitalization due to COVID-19, none of the students required hospital care (Table 2).

Table 2. Descriptive
analysis of variables related to the COVID-19 pandemic among Biological and Health Sciences students. 2020 (n = 618).

The presence of post-traumatic stress symptoms verified by the Impact of Event Scale - Revised (IES-R) showed a prevalence of 32.7% (n = 202) among university students of Biological and Health Sciences. Additionally, the mean and median of the instrument score and its subscales were calculated, of which results are shown in Chart 1.

Chart 1
Application of the Impact of Event Scale - Revised (IES-R) among Biological and Health Sciences students during the COVID-19 pandemic. 2020 (n = 618).

The bivariate analysis carried out using Poisson Regression, with robust variance, showed a significant association (p ≤ 0.05) between PTSD and being female, having another sexual orientation (homosexual, bisexual, pansexual, asexual), having a chronic health condition, attending the Physical Education course, reporting one’s self-perception of health as regular or poor, presence of depressive symptoms, anxiety and stress, consuming alcohol and tobacco more than 10 times in the last 30 days, thoughts about suicide in the previous year and the presence of flu-like symptoms during the pandemic (Table 3).

Table 3
Post-traumatic stress symptoms mediated by the SARS-CoV-2 pandemic and crude association of independent variables among university students. 2020 (n = 618).

In the multiple model with adjusted PR, 95%CI and p ≤ 0.05, the factors that maintained a statistically significant association with the presence of Post-Traumatic Stress Disorder symptoms induced by the COVID-19 pandemic among students of Biological Sciences and Health were the presence of symptoms of depression, stress and anxiety, the presence of regular or poor self-perception of health, the presence of flu-like symptoms during the pandemic and the academic course (Table 4).

Table 4
Post-traumatic stress symptoms mediated by the SARS-CoV-2 pandemic and associated factors among University students. 2020 (n = 618).

DISCUSSION

This study assessed 618 students from courses in the area of Biological and Health Sciences during the Covid-19 pandemic. The multivariate analysis showed a significant association between PTSD and the presence of depression, stress and anxiety symptoms, a negative self-perception of health, the presence of flu-like symptoms during the pandemic and attending the Dentistry course.

The prevalence of severe depression symptoms, severe to very severe anxiety and severe to very severe stress observed in the assessed population is noteworthy, being found 18.8%, 31.6% and 30.9% of the participants, respectively. Furthermore, a significant association was observed between PTSD and the presence of these symptoms. The anxiety levels among university students during the Covid-19 pandemic showed that their mental health was affected, considering that 24.9% of this population had some type of anxiety symptoms, ranging from mild to severe2121. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the Covid-19 epidemic on college students in China. Psychiatry Res. 2020 May;287 Disponível em: https://doi.org/10.1016/j.psychres.2020.112934.
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. This indicates the genesis of mental suffering during the pandemic period and as a direct result of it. In this sense, feelings of discomfort, worry, restlessness, loss of the meaning of life, imminence of panic and feelings of not knowing what to do were reported2222. Araújo FJO, Lima LSA, Cidade PIM, Nobre CB, Neto RML. Impact of Sars-Cov-2 and its reverberation in global higher education and mental health. Psychiatry Res . 2020; 288.Disponível em: https://doi.org/10.1016/j.psychres.2020.112977.
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, corroborating the high prevalence of symptoms of anxiety, stress and depression and their association with the symptoms of PTSD.

A systematic review with meta-analysis carried out in 20212323. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad P-G, Mukunzi JN, McIntee SE, et al. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the Covid-19 pandemic: a systematic review and meta-analysis. Psychiatry Res . 2021 Jan;295. Disponível em: https://doi.org/10.1016/j.psychres.2020.113599.
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, which included a total of 55 studies and considered 68 independent samples or subsamples, showed that research carried out in populations affected by the SARS-CoV-2 outbreak indicated that the risk of contamination, infection and death of loved ones, virus containment measures, social isolation and loneliness are among the main risk factors associated with psychological distress, anxiety and stress. The disruption of the academic routine, practical classes and curricular internships, culminating in the distancing from friends and classmates, as well as the concern regarding the delay in activities and continuation of the course constituted other factors related to the change in mental health during the pandemic2424. Gundim VA, Encarnação JP, Santos FC, Santos JE, Vasconcellos EA, Souza RC. Saúde mental de estudantes universitários durante a pandemia de Covid-19. Rev Baiana Enferm. 2021;35:e37293.. That said, it is evident that the pandemic, by increasing the levels of mental suffering, had an important impact on the high prevalence of PTSD, depression, anxiety, insomnia and psychological suffering2323. Cénat JM, Blais-Rochette C, Kokou-Kpolou CK, Noorishad P-G, Mukunzi JN, McIntee SE, et al. Prevalence of symptoms of depression, anxiety, insomnia, posttraumatic stress disorder, and psychological distress among populations affected by the Covid-19 pandemic: a systematic review and meta-analysis. Psychiatry Res . 2021 Jan;295. Disponível em: https://doi.org/10.1016/j.psychres.2020.113599.
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Moreover, it is possible that the sudden change from the traditional teaching methodology in the classroom to remote learning negatively influenced the students’ mental health, since the frustration with the structure and approach of online teaching may have caused the unsatisfactory acquisition of knowledge by university students1111. Nambiar D. The impact of online learning during Covid-19: students’ and teachers’ perspective. International Journal of Indian Psychology. 2020 June 25;8(2). Disponível em: https://doi.org/2010.25215/0802.094.
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, and, consequently, the increase in anxiety and stress levels. One must also consider the impact of social isolation and the impediment of usual social interactions due to the mitigation strategies caused by the Covid-19 pandemic, since, together, these factors produced negative psychological consequences, which decompensated or intensified previous symptoms of mental disorders and, in parallel, limited access to psychiatric services to provide support to these diseases2525. Berardelli I, Sarubbi S, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, et al. The impact of the Covid-19 pandemic on suicide ideation and suicide attempts in a sample of psychiatric inpatients. Psychiatry Res . 2021;303. Disponível em: https://doi.org/10.1016/j.psychres.2021.114072.
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. Similarly, it is possible that social isolation has increased the experience of loneliness2626. Krause KD. Implications of the Covid-19 pandemic on LGBTQ communities. J Public Health Manag Pract. 2021 Jan;27(1):S69-71..

Additionally, psychosocial stressors may also have contributed to the intensification of mental distress during the pandemic2525. Berardelli I, Sarubbi S, Rogante E, Cifrodelli M, Erbuto D, Innamorati M, et al. The impact of the Covid-19 pandemic on suicide ideation and suicide attempts in a sample of psychiatric inpatients. Psychiatry Res . 2021;303. Disponível em: https://doi.org/10.1016/j.psychres.2021.114072.
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, as they were associated with relatively high rates of anxiety, depression, PTSD and symptoms of psychological distress in the population affected by Covid-19 in several countries2727. Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of Covid-19 pandemic on mental health in the general population: a systematic review. J Affect Disord . 2020 Dec 1º;277(1):55-64.. From this perspective, having relatives or acquaintances infected with the SARS-CoV-2 virus was described as an important stressor, intrinsically associated with anxiety among university students. As a result, the presence of mental health disorders, especially depression, highlighted behavioral changes and the adoption of inappropriate health habits, such as substance abuse2828. Papp LM, Kouros CD. Effect of Covid-19 disruptions on young adults’ affect and substance use in daily life. Psychol Addict Behav. 2021 June;35(4)391-401.. Therefore, the increase in alcohol consumption, on the one hand, emerges as part of a maladjusted coping strategy1010. Maia BR, Dias PC. Ansiedade, depressão e estresse em estudantes universitários: o impacto da Covid-19. Estud Psicol. 2020;37: 1-8. doi: https://doi.org/10.1590/1982-0275202037e200067.
https://doi.org/10.1590/1982-0275202037e...
, as a result of the stressors concerning the pandemic; and, on the other hand, it aggravates the psychopathological symptoms2929. Carbia C, García-Cabrerizo R, Cryan JF, Dinan TG. Associations between mental health, alcohol consumption and drinking motives during Covid-19 second lockdown in Ireland. Alcohol Alcohol. 2022 Mar 12;57(2):211-8. initially present, increasing their prevalence.

This study also showed the prevalence of a negative self-perception of health (32.7%), above that found in other studies, which is, in general, around 20%3030. Lindemann IL, Reis NR, Mintem GC, Mendoza-Sassi RA. Self-perceived health among adult and elderly users of primary health care. Cienc Saude Colet. 2019 Jan;24(1):45-52.. This difference is perhaps related to the specificity and particularities of the assessed sample, such as the experience of changes related to online teaching, the academic overload and the fact that they are students of health sciences courses, in addition to the entire current context of the Covid-19 pandemic and its implications. The self-assessment of one’s health status subjectively seeks to describe the individual’s current health conditions and constitutes one of the most often used variables in epidemiological studies3131. Smith KV, Goldman N. Measuring health status: self-, interviewer, and physician reports of overall health. J Aging Health. 2011 Mar;23(2):242-66.. There is an important association between regular or poor self-perception of health and the development of signs of psychological stress, which predisposes the individual to develop mental health disorders, including PTSD3232. Williams G, Di Nardo F, Verma A. The relationship between self-reported health status and signs of psychological distress within European urban contexts. EurJ Public Health. 2017 Apr 25;27(Suppl 2):68-73., which, therefore, may have contributed to the validity of the significant association found in the multiple model carried out in this research.

The association between the presence of flu-like symptoms and PTSD found in this study was significant (p ≤ 0.001), with 60.3% of those assessed who had these symptoms also manifesting PTSD symptoms. Hence, it is possible that this variable is an important contributing factor to the development of PTSD, since people who had flu-like symptoms during the SARS-CoV-2 outbreak had a harmful impact on their physical and mental health due to accusations of spreading the virus, in addition to suffering hostile attitudes that caused them psychological stress, as verified in the study by Baohua Zhen (2022), carried out with 1,153 university students. Also according to this study, the Covid-19 pandemic can be seen as a traumatic event, having the capacity to cause PTSD symptoms, since among young individuals who experienced and suffered with the pandemic and the quarantine caused by the coronavirus, many had their aggressive behaviors amplified, with a tendency to experience high levels of anger and fear3333. Zhen B, Yao B, Zhou X. How does parent-child communication affects posttraumatic stress disorder and growth in adolescents during the Covid-19 pandemic? The mediating roles of self-compassion and disclosure. J Affect Disord . 2022 June;306:1-8..

As for the undergraduate courses in which the respondents were enrolled, there was an association of a higher prevalence of PTSD symptoms among Dentistry students in the multiple model (PR=1.25), which is perhaps justified by the fact that dental procedures involve the production and dissemination of droplets and aerosols3434. Meethil AP, Saraswat S, Chaudhary PP, Dabdoub SM, Kumar PS. Sources of Sars-CoV-2 and other microorganisms in dental aerosols. J Dent Res. 2021 July;100(8):817-23.. Saliva, with which dentists and Dentistry students are in constant contact, originates from the salivary glands, which act as reservoirs of the Sars-CoV-2 virus, thus putting these individuals at greater risk3535. Chen L, Zhao J, Peng J, Li X, Deng X, Geng Z, et al. Detection of SarS‐CoV‐2 in saliva and characterization of oral symptoms in Covid‐19 patients. Cell Prolif. 2020 Oct 19;53(12). Disponível em: https://doi.org/10.1111/cpr.12923.
https://doi.org/10.1111/cpr.12923...
),(3636. Matuck BF, Dolhnikoff M, Duarte‐Neto AN, Maia G, Gomes SC, Sendyk DI, et al. Salivary glands are a target for SARS‐CoV‐2: a source for saliva contamination. The Journal of Pathology. 2021 May 21;254(3):239-43.. A study carried out among dentists, in 2020, with a sample of 669 participants (n = 669) from more than 30 countries around the world, found that more than 2/3 of the participants had symptoms of anxiety and fear related to the effects of the COVID-19 pandemic, making them more susceptible to the development of mental disorders, such as PTSD3737. Ahmed MA, Jouhar R, Ahmed N, Adnan S, Aftab M, Zafar MS, et al. Fear and practice modifications among dentists to combat novel coronavirus disease (Covid-19) outbreak. Int J Environ Res Public Health. 2020 Apr 19;17(8). Disponível em: https://doi.org/10.3390/ijerph17082821.
https://doi.org/10.3390/ijerph17082821...
. However, it is worth highlighting the important association with PTSD found in this study in medical students (PR=1.14), which may be related to economic issues, the effects of the quarantine on their daily routines and academic changes3838. Messiano JB, Bergantini RF, Serafim TM, Baptista VAF, Tambellini MEN, Bordonal TD, et al. Efeitos da pandemia na saúde mental de acadêmicos de medicina do 1º ao 4º ano em faculdade do noroeste paulista. Cuid Enferm. 2021;15(1):43-52.. Added to these factors, there was the interruption of plans and the uncertainty regarding their future in the professional career77. S.M. Didar-Ul Islam, Md. Bodrud-Doza, Rafid Mahmud Khan, Md. Abidul Haque, Mohammed A. Mamun. Exploring Covid-19 stress and its factors in Bangladesh: a perception-based study. Heliyon. 2020 July;6(7):e04399..

It is necessary to emphasize, however, the contribution of a significant impact factor in academic life, during the pandemic period - online teaching. Since online communication has the same objective as face-to-face teaching, i.e., the transfer of information, knowledge, thoughts, among others3939. Alawamleh M, Al-Twait LM, Al-Saht GR. The effect of online learning on communication between instructors and students during Covid-19 pandemic. Asian Education and Development Studies. 2022 Mar 3;11(2):380-400., it is possible that the sudden change from the traditional approach in the classroom (in-person approach) to remote learning, has contributed negatively to the students’ mental health status, as the method used to attain this objective was modified. In agreement with other studies, it was possible to establish, therefore, that the pandemic and its associated factors impacted the academic life and health of university students and their families, considering the observation of negative emotional reactions such as stress, anxiety, grief, anger and panic, as a result of concerns about delaying academic activities and fear of becoming ill2424. Gundim VA, Encarnação JP, Santos FC, Santos JE, Vasconcellos EA, Souza RC. Saúde mental de estudantes universitários durante a pandemia de Covid-19. Rev Baiana Enferm. 2021;35:e37293..

CONCLUSION

This study investigated the self-perception of the psychological status among university students of Biological and Health Sciences during the COVID 19 pandemic. It was found that there was a significant impact on the mental health of these students, with the presence of symptoms of depression, anxiety and stress above the levels found in the scientific literature and, consequently, a high prevalence of PTSD. University students constitute a vulnerable population to psychological problems, and who, during public health emergencies, may have their mental health more affected than the general population. As this is a population with a tendency to experience suicidal behaviors, they require greater attention, help and support from the family, society and academic institutions. The findings of this study indicate the importance of implementing earlier intervention programs and stringent actions, by providing evidence for universities and the government to implement public policies aiming to minimize this problem, whether in the reflection on the role they play in the promotion and prevention of psychological suffering, acting energetically against this problem, or through qualified psychological services, aimed at university students and their families. Moreover, additional longitudinal studies may reinforce our findings.

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    Evaluated by double blind review process.
  • SOURCES OF FUNDING

    The authors declare no sources of funding.
Chief Editor: Rosiane Viana Zuza Diniz. Associate editor: Margareth Rodrigues Salerno.

Publication Dates

  • Publication in this collection
    15 May 2023
  • Date of issue
    2023

History

  • Received
    21 June 2022
  • Accepted
    30 Jan 2023
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