Defining characteristics predicting mental health disorders among undergraduate students in the post-COVID-19 era: a multicenter cross-sectional study

Moura, Caroline de Castro; Toledo, Luana Vieira; Boscarol, Gabriela Tavares; Chaves, Rafael Lopes; Nogueira, Denismar Alves; Marinho, Carine Alves da Costa; Alves, Bruna de Oliveira; Lourenço, Bárbara Guimarães; Chaves, Érika de Cássia Lopes; Chianca, Tânia Couto Machado

doi:10.1590/1518-8345.7741.4671

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Rev. Latino-Am. Enfermagem 33 • 2025 • https://doi.org/10.1590/1518-8345.7741.4671 linkcopy

Defining characteristics predicting mental health disorders among undergraduate students in the post-COVID-19 era: a multicenter cross-sectional study^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to evaluate defining characteristics of nursing diagnoses that are predictors of mental health disorders among undergraduate students in the post-COVID-19 era.

Method: cross-sectional, multicenter study conducted with undergraduate students from four public universities in the state of Minas Gerais. Data were collected through a structured, online questionnaire with sociodemographic and clinical variables. The presence of defining characteristics included in the Nursing Diagnoses of Anxiety, Change Stress Syndrome; Post-Trauma Syndrome; Stress Overload and Chronic Sadness, present in the NANDA-I taxonomy, was also investigated through self-report. The Depression, Anxiety and Stress Scale and the Impact of Events Scale-Revised were also used. Multivariate logistic regression analysis was performed to determine the defining characteristics that were configured as predictors of mental health disorders. Adjusted odds ratios were estimated, along with 95% confidence intervals, at 5% significance.

Results: 2,349 undergraduate students participated in the study. The presence of 24 physical, behavioral, cognitive, and emotional defining characteristics of the nursing diagnoses in question was investigated. Of these, 13 emerged as predictors for anxiety symptoms; 15 for stress symptoms; 11 for depression symptoms; and 15 for post-traumatic stress disorder.

Conclusion: physical, behavioral, cognitive, and emotional defining characteristics of NANDA-I nursing diagnoses were evidenced as predictors for the development of mental health disorders in university students in the post-COVID-19 era.

Descriptors:
Signs and Symptoms; Mental Health; Universities; Students; COVID-19; Nursing

Highlights:

(1) Mental health disorders are prevalent among college students in the post-COVID-19 era. (2) Nursing diagnoses related to mental health are prevalent among students. (3) Defining characteristics have emerged as predictors of mental health disorders. (4) Interventions to promote mental health in this population are needed.

Variables	f*	(% ^† )
Gender
Male	572	24.4
Female	1.777	75.6
Skin color
White	1.353	57.6
Yellow	27	1.1
Brown	676	28.8
Black	287	12.2
Indigenous	6	0.3
Marital status
Single	2.203	93.8
Married/stable union	132	5.6
Widower	1	0.1
Divorced	13	0.6
Living
Alone	410	17.5
With Family	942	40.1
Pension	58	2.5
Shared house	794	33.8
student accommodation	145	6.2
Family income in minimum wages ^‡
Up to 3	1.380	58.7
4 or more	969	41.3
Current work activity	606	25.8
Student assistance at the moment	621	26.4
Student scholarship at the moment	476	20.3
Clinical diagnosis of mental health disorders	1.337	56.9
Use of psychotropic drugs	956	40.7
Follow-up with a psychiatrist
No	1.638	69.7
I already did it before the pandemic	302	12.9
I started doing it during/after the pandemic	409	17.4
Follow-up with a psychologist
No	1.254	53.4
I already did it before the pandemic	461	19.6
I started doing it during/after the pandemic	634	27.0

		Anxiety symptoms	p-value	Stress symptoms	p-value	Depression symptoms	p-value	*Post-traumatic stress disorder f(%** ^† )	p-value
		*f (%** ^† )	p-value	*f (%** ^† )	p-value	*f (%** ^† )	p-value	*Post-traumatic stress disorder f(%** ^† )	p-value
Physical defining characteristics
Change in the sleep-wake cycle ^‡§	No	329 (18.2)	<0.001	326 (18.0)	<0.001	335 (18.5)	<0.001	130 (13.1)	<0.001
Change in the sleep-wake cycle ^‡§	Yes	1475 (81.8)	<0.001	1490 (82.0)	<0.001	1479 (81.5)	<0.001	864 (86.9)	<0.001
Increased sweating ^‡	No	900 (49.9)	<0.001	917 (50.5)	<0.001	940 (51.8)	<0.001	433 (43.6)	<0.001
Increased sweating ^‡	Yes	904 (50.1)	<0.001	899 (49.5)	<0.001	874 (48.2)	<0.001	561 (56.4)	<0.001
Dry mouth ^‡	No	825 (45.7)	<0.001	871 (48.0)	<0.001	882 (48.6)	<0.001	391 (39.3)	<0.001
Dry mouth ^‡	Yes	979 (54.3)	<0.001	945 (52.0)	<0.001	932 (51.4)	<0.001	603 (60.7)	<0.001
Altered breathing pattern ^‡	No	636 (35.3)	<0.001	657 (36.2)	<0.001	701 (38.6)	<0.001	284 (28.6)	<0.001
Altered breathing pattern ^‡	Yes	1168 (64.7)	<0.001	1159 (63.8)	<0.001	1113 (61.4)	<0.001	710 (71.4)	<0.001
Heart palpitations ^‡\|\|	No	644 (35.7)	<0.001	694 (38.2)	<0.001	720 (39.7)	<0.001	308 (31.0)	<0.001
Heart palpitations ^‡\|\|	Yes	1160 (64.3)	<0.001	1122 (61.8)	<0.001	1094 (60.3)	<0.001	686 (69.0)	<0.001
Muscle tension ^‡¶	No	373 (20.8)	<0.001	362 (19.9)	<0.001	408 (22.5)	<0.001	168 (16.9)	<0.001
Muscle tension ^‡¶	Yes	1431 (79.3)	<0.001	1454 (80.1)	<0.001	1406 (77.5)	<0.001	826 (83.1)	<0.001
Headache ^\|\|	No	641 (35.5)	<0.001	646 (35.6)	<0.001	6607 (36.8)	<0.001	296 (29.8)	<0.001
Headache ^\|\|	Yes	1163 (64.5)	<0.001	1170 (64.4)	<0.001	1147 (63.2)	<0.001	698 (70.2)	<0.001
Nausea ^‡\|\|	No	1080 (59.9)	<0.001	1101 (60.6)	<0.001	1117 (61.6)	<0.001	545 (54.8)	<0.001
Nausea ^‡\|\|	Yes	724 (40.1)	<0.001	715 (39.4)	<0.001	697 (38.4)	<0.001	449 (45.2)	<0.001
Tightness in the chest ^‡	No	591 (32.8)	<0.001	625 (34.4)	<0.001	646 (35.6)	<0.001	264 (26.6)	<0.001
Tightness in the chest ^‡	Yes	1213 (67.2)	<0.001	1191 (65.6)	<0.001	1168 (64.4)	<0.001	730 (73.4)	<0.001
Diarrhea ^‡\|\|	No	1235 (68.5)	<0.001	1245 (68.6)	<0.001	1260 (69.5)	<0.001	640 (64.4)	<0.001
Diarrhea ^‡\|\|	Yes	569 (31.5)	<0.001	571 (31.4)	<0.001	554 (30.5)	<0.001	354 (994)	<0.001
Facial flushing ^‡	No	1427 (79.1)	<0.001	1441 (79.4)	<0.001	1453 (80.1)	<0.001	756 (76.1)	<0.001
Facial flushing ^‡	Yes	373 (20.7)	<0.001	371 (20.4)	<0.001	357 (19.7)	<0.001	238 (23.9)	<0.001
Behavioral defining characteristics
Psychomotor agitation ^‡	No	150 (8.3)	<0.001	131 (7.2)	<0.001	180 (9.9)	<0.001	61 (6.1)	<0.001
Psychomotor agitation ^‡	Yes	1654 (91.7)	<0.001	1685 (92.8)	<0.001	1634 (90.1)	<0.001	933 (93.9)	<0.001
Easy cry ^‡	No	490 (27.2)	<0.001	483 (26.6)	<0.001	521 (28.7)	<0.001	214 (21.5)	<0.001
Easy cry ^‡	Yes	1314 (72.8)	<0.001	1333 (73.4)	<0.001	1293 (71.3)	<0.001	780 (78.5)	<0.001
Increased impatience ^¶	No	219 (12.1)	<0.001	169 (9.3)	<0.001	214 (11.8)	<0.001	80 (8.0)	<0.001
Increased impatience ^¶	Yes	1585 (87.9)	<0.001	1647 (90.7)	<0.001	1600 (88.2)	<0.001	914 (92.0)	<0.001
Decreased productivity ^‡	No	287 (15.9)	<0.001	292 (16.1)	<0.001	258 (14.2)	<0.001	123 (12.4)	<0.001
Decreased productivity ^‡	Yes	1517 (84.1)	<0.001	1524 (83.9)	<0.001	1556 (85.8)	<0.001	871 (87.6)	<0.001
Low self-esteem ^§	No	266 (14.9)	<0.001	273 (15.1)	<0.001	246 (13.7)	<0.001	96 (9.7)	<0.001
Low self-esteem ^§	Yes	1525 (85.1)	<0.001	1531 (84.9)	<0.001	1556 (86.3)	<0.001	898 (90.3)	<0.001
Cognitive defining characteristics
Altered attention ^‡\|\|	No	212 (11.8)	<0.001	201 (11.1)	<0.001	209 (11.5)	<0.001	87 (8.8)	<0.001
Altered attention ^‡\|\|	Yes	1592 (88.2)	<0.001	1615 (88.9)	<0.001	1605 (88.5)	<0.001	907 (91.2)	<0.001
Frequent forgetfulness ^‡	No	291 (16.1)	<0.001	280 (15.4)	<0.001	296 (16.3)	<0.001	117 (11.8)	<0.001
Frequent forgetfulness ^‡	Yes	1513 (83.9)	<0.001	1536 (84.6)	<0.001	1518 (83.7)	<0.001	877 (88.2)	<0.001
Emotional defining characteristics
Excessive worry ^‡§	No	110 (6.1)	<0.001	96 (5.3)	<0.001	126 (6.9)	<0.001	24 (2.4)	<0.001
Excessive worry ^‡§	Yes	1694 (93.9)	<0.001	1720 (94.7)	<0.001	1688 (93.1)	<0.001	970 (97.6)	<0.001
Frustration ^§	No	195 (10.8)	<0.001	190 (10.5)	<0.001	154 (8.5)	<0.001	68 (6.8)	<0.001
Frustration ^§	Yes	1609 (89.2)	<0.001	1626 (89.5)	<0.001	1660 (91.5)	<0.001	926 (93.2)	<0.001
Loneliness ^§	No	437 (24.2)	<0.001	421 (23.2)	<0.001	401 (22.1)	<0.001	178 (17.9)	<0.001
Loneliness ^§	Yes	1367 (75.8)	<0.001	1395 (76.8)	<0.001	1413 (77.9)	<0.001	816 (82.1)	<0.001
Fear ^‡§\|\|	No	305 (16.9)	<0.001	326 (18.0)	<0.001	325 (17.9)	<0.001	114 (11.5)	<0.001
Fear ^‡§\|\|	Yes	1499 (83.1)	<0.001	1490 (82.0)	<0.001	1489 (82.1)	<0.001	880 (88.5)	<0.001
Anger ^§\|\|¶	No	557 (30.9)	<0.001	521 (28.7)	<0.001	538 (29.7)	<0.001	225 (22.6)	<0.001
Anger ^§\|\|¶	Yes	1247 (69.1)	<0.001	1295 (71.3)	<0.001	1276 (70.3)	<0.001	769 (77.4)	<0.001
Sadness**	No	266 (14.7)	<0.001	273 (15.0)	<0.001	246 (13.6)	<0.001	68 (6.8)	<0.001
Sadness**	Yes	1538 (85.3)	<0.001	1543 (85.0)	<0.001	1568 (86.4)	<0.001	926 (93.2)	<0.001

		Anxiety symptoms		Stress symptoms		Depression symptoms		Post-traumatic stress disorder
	Categories	ORA* (CI 95% ^† )	p-value	ORA* (CI 95% ^† )	p-value	ORA* (CI 95% ^† )	p-value	ORA* (CI 95% ^† )	p-value
Physical defining characteristics
Change in the sleep-wake cycle ^§\|\|	No ^‡	-	-	-	-	1		1
Change in the sleep-wake cycle ^§\|\|	Yes	-	-	-	-	1.405 (1.054-1.872)	0.021	1.437 (1.111-1.858)	0.006
Increased sweating ^§	No ^‡	1		1		-	-	1
Increased sweating ^§	Yes	1.463 (1.075-1.991)	0.015	1.382 (1.016-1.878)	0.039	-	-	1.355 (1.108-1.658)	0.003
Dry mouth ^§	No ^‡	1		-	-	1		1
Dry mouth ^§	Yes	3.312 (2.369-4.630)	<0.001	-	-	1.613 (1.209-2.152)	0.001	1.551 (1.265-1.901)	<0.001
Altered breathing pattern ^§	No ^‡	1		1		-	-	1
Altered breathing pattern ^§	Yes	1.618 (1.170-2.238)	0.004	1.877 (1.353-2.604)	<0.001	-	-	1.373 (1.097-1.719)	0.006
Heart palpitations ^§¶	No ^‡	1		1		-	-	1
Heart palpitations ^§¶	Yes	3.316 (2.379-4.623)	<0.001	1.455 (1.058-2.002)	0.021	-	-	1.319 (1.062-1.638)	0.012
Muscle tension ^§**	No ^‡	-	-	1		-	-	-	-
Muscle tension ^§**	Yes	-	-	1.444 (1.072-1.943)	0.016	-	-	-	-
Headache ^¶	No ^‡	-	-	1		-	-	1
Headache ^¶	Yes	-	-	1.298 (0.966-1.744)	0.083	-	-	1.299 (1.054-1.599)	0.014
Nausea ^§¶	No ^‡	1		1		1		1
Nausea ^§¶	Yes	2.707 (1.822-4.020)	<0.001	1.628 (1.109-2.390)	0.013	1.952 (1.397-2.726)	<0.001	1.226 (0.933-1.514)	0.058
Tightness in the chest ^§	No ^‡	1		-	-	-	-	-	-
Tightness in the chest ^§	Yes	1.422 (1.041-1.941)	0.027	-	-	-	-	-	-
Behavioral defining characteristics
Psychomotor agitation ^§	No ^‡	1		1		-	-	1
Psychomotor agitation ^§	Yes	2.238 (1.614-3.104)	<0.001	3.233 (2.312-4.522)	<0.001	-	-	1.425 (1.009-2.013)	0.045
Easy cry ^§	No ^‡	1		1		-	-	1
Easy cry ^§	Yes	1.550 (1.170-2.053)	0.002	1.813 (1.358-2.420)	<0.001	-	-	1.343 (1.076-1.678)	0.009
Increased impatience**	No ^‡	-	-	1		1		-	-
Increased impatience**	Yes	-	-	2.225 (1.601-3.093)	<0.001	1.319 0.953-1.825)	0.095	-	-
Decreased productivity ^§	No ^‡	-	-	-	-	1		-	-
Decreased productivity ^§	Yes	-	-	-	-	2.449 (1.827-3.282)	<0.001	-	-
Low self-steem ^\|\|	No ^‡	1		1		1		1
Low self-steem ^\|\|	Yes	2.026 (1.476-2.782)	<0.001	1.632 (1.189-2.239)	0.002	2.205 (1.649-2.949)	<0.001	1.696 (1.272-2.260)	<0.001
Cognitive defining characteristics
Altered attention ^§¶	No ^‡	-	-	1		-	-	-	-
Altered attention ^§¶	Yes	-	-	1.649 (1.169-2.325)	0.004	-	-	-	-
Frequent forgetfulness ^§	No ^‡	1		1		1		1
Frequent forgetfulness ^§	Yes	1.433 (1.061-1.934)	0.019	1.644 (1.197-2.257)	0.002	1.362 (1.009-1.838)	0.043	1.547 (1.189-2.013)	0.001
Emotional defining characteristics
Excessive worry ^§\|\|	Não ^‡	1		1		1		1
Excessive worry ^§\|\|	Yes	1.728 (1.209-2.471)	0.003	2.698 (1.868-3.897)	<0.001	1.539 (1.075-2.205)	0.019	2.825 (1.764-4.523)	<0.001
Frustration ^\|\|	No ^‡	1		-	-	1		-	-
Frustration ^\|\|	Yes	1.412 (0.991-2.012)	0.056	-	-	2.454 (1.793-3.359)	<0.001	-	-
Loneliness ^\|\|	No ^‡	-	-	1		1		1
Loneliness ^\|\|	Yes	-	-	1.677 (1.237-2.273)	0.001	1.822 (1.378-2.407)	<0.001	1.420 (1.120-1.801)	0.004
Fear ^§\|\|¶	No ^‡	1		-	-	1		1
Fear ^§\|\|¶	Yes	2.036 (1.508-2.748)	<0.001	-	-	1.305 (0.972-1.152)	0.076	1.677 (1.281-2.196)	<0.001
Anger ^\|\|¶ **	No ^‡	-	-	1		1		1
Anger ^\|\|¶ **	Yes	-	-	2.213 (1.641-2.986)	<0.001	1.923 (1.446-2.557)	<0.001	1.597 (1.287-1.983)	<0.001
Sadness ^††	No ^‡	1		1		1		1
Sadness ^††	Yes	1.487 (1.062-2.082)	0.021	1.572 (1.118-2.211)	0.009	2.557 (1.871-3.472)	<0.001	1.522 (1.091-2.123)	0.013

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3387 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[1] *f = Absolute frequency; ^†% = Relative frequency; ^‡Minimum wage value at the time of data collection: R$1,320.00 reais (Brazilian currency), in 2023

Defining characteristics predicting mental health disorders among undergraduate students in the post-COVID-19 era: a multicenter cross-sectional study*

Highlights:

Defining characteristics predicting mental health disorders among undergraduate students in the post-COVID-19 era: a multicenter cross-sectional study^*