Mental health and everyday life of occupational therapy students facing Covid-19: possible impacts and repercussions

Abstract

This research aimed to identify the impacts on mental health and the daily lives of students of the undergraduate course in Occupational Therapy at a Federal Public University in the face of the COVID-19 coping scenario. This is an exploratory and descriptive study, with a quantitative and qualitative approach. For data collection, a semi-structured questionnaire organized in Google Forms was used. Fifty-three undergraduate students from the first to the last year of the course participated in the study. The results show that 94% of the participants are female, aged between 20 and 25 years (78%). Before the pandemic, students performed a wide range of weekly activities, 68% of whom had no previous mental health issues, or had no difficulties that significantly impacted their lives. With the advent of the pandemic and its consequences, the study found that 94% of participants observed their mental health impacted, and of these, 92% showed anxiety as the most recurrent manifestation. It was also found that practically all activities that made up students' daily lives before the COVID-19 pandemic were altered in some way, with the socialization category being the second most cited. Given the current scenario, in which the pandemic has been in existence for more than a year, it is important to investigate how and which coping strategies not only students but also the general population, have adopted to deal with the persistent and permanent challenges. Thus, it points to the need and importance of investing in research that deepens the understanding of these impacts and the possible coping strategies adopted.

Keywords:
Pandemic; COVID-19; Mental Health; Students; Occupational Therapy

Resumo

A presente pesquisa teve como objetivo identificar os impactos na saúde mental e no cotidiano dos estudantes do curso de graduação em terapia ocupacional de uma universidade pública federal frente ao cenário de enfrentamento da COVID-19. Trata-se de um estudo exploratório e descritivo, de abordagem quantiqualitativa. Para coleta de dados, utilizou-se um questionário semiestruturado organizado no Google Formulários®. Participaram do estudo 53 graduandos do primeiro ao último ano do curso. Os resultados apontam que 94% dos participantes são do gênero feminino, com idade entre 20 e 25 anos (78%). Antes da pandemia, os estudantes realizavam uma vasta gama de atividades semanais, sendo que 68% não apresentavam questões prévias de saúde mental ou não apresentavam dificuldades que impactavam a sua vida de forma significativa. Com o advento da pandemia e suas consequências, o estudo apontou que 94% dos participantes observaram sua saúde mental impactada e, desses, 92% sinalizaram a ansiedade como a manifestação mais recorrente. Verificou-se ainda que praticamente todas as atividades que compunham o cotidiano dos estudantes antes da pandemia da COVID-19 foram alteradas de alguma maneira, sendo a categoria socialização a segunda mais citada. Diante do cenário atual de permanência da pandemia há mais de um ano, importa investigar como e quais estratégias de enfrentamento os estudantes, mas também a população geral, têm adotado para lidar com os persistentes e permanentes desafios. Assim, aponta-se para a necessidade e importância de se investir em pesquisas que aprofundem a compreensão desses impactos e das possíveis estratégias de enfrentamento adotadas.

Palavras-chave:
Pandemia; COVID-19; Saúde Mental; Estudantes; Terapia Ocupacional

Introduction

The COVID-19 pandemic has become a major threat to global health (Ferguson et al., 2020). The high transmissibility of the virus, associated with a large number of deaths in a few months, alerted the governments of different countries about the severity of the pandemic, leading the authorities to adopt large-scale interventions to contain the number of new infections (Sarti et al., 2020; Zhu et al., 2020).

In the Brazilian scenario, the President of the Republic sanctioned Law 13,979, on February 6, 2020, which provided for measures to deal with the public health emergency arising from the coronavirus that the authorities could adopt. In line with the aforementioned law, the Governor of the State of São Paulo, in Decree Decree 64,881, on March 22, 2020, determined a quarantine in the State of São Paulo, recommending that the movement of people be limited to essential activities (Brasil, 2020a). These measures have varied in intensity and guidelines since when they were initially enacted, according to the evolution of the country's epidemiological scenario.

In the education area, the Ministry of Education (MEC) authorized, through Ordinances 343 and 345, published respectively on March 17 and 19, 2020, that public and private higher education institutions replace in-person courses with classes distance learning, using information and communication technology for courses that have already begun. These measures have also been periodically updated depending on the epidemiological scenario in each region of the country (Brasil, 2020b, 2020c).

Although the effects of COVID-19 focus, in the first instance, on people's physical health, the current situation has revealed its potential for triggering intense psychological distress in the general population (United Nations, 2020). The social distancing measure, widely adopted in different countries, as well as in Brazil, can also negatively impact the mental health of the population although based on scientific evidence and essential for the preservation of health (Schmidt et al., 2020a). This is because, in practice, the strategies adopted to make social distancing possible – the suspension of events and face-to-face meetings between people; suspension of work activities, cancellation or postponement of personal projects; the closing of businesses in general and the suspension of educational activities, including Universities - impose restrictions that produce significant changes in people's lives, sometimes drastically transforming what used to be familiar or even making aspects of everyday life that used to be simple. For many people, ordinary life has changed and is changing in a way that produces a kind of indefinite suspension of what used to be normal life (Usher et al., 2020).

We need to emphasize that the aforementioned aspects and constituent elements of daily life - which underwent significant changes/suspension with the advent of measures to contain the transmission of COVID-19 - are precisely those that, along with so many others, shape lifestyles, quality of life and well-being, conditions that are at the base of what is understood here by mental health. In other words, according to the Organização Pan-Americana da Saúde (2016), mental health transcends an understanding of the mere absence of mental disorders, constituting an essential part that integrates the health of individuals and communities, being influenced by contextual, socioeconomic, and biological factors. Therefore, it is a condition whose well-being allows the person to operate in the world through their abilities and to deal with the tensions inherent in life. Thus,

we can think that life implies processuality, movement, creation. The living human being is in constant transformation. A lot of things can happen to those who are alive, a lot of bad weather and mishaps, and a lot of good things too. To continue living, we have to, somehow, incorporate these events, but this implies the creation of new organizations, new bodies, always provisional forms of life (Lima, 2006, p. 119).

From this understanding, mental health and well-being are extremely important conditions for the configuration of individual and collective life, enabling people to act, think, feel and interact (Organização Pan-Americana da Saúde, 2016), building daily ways of life and living.

We argue that situations like this, inaugurated by the COVID-19 pandemic, by imposing such drastic and indefinite changes to people's lives, can reach subjective dimensions of existence in a very particular and singular way, and can sometimes compromise pillars of support of emotional life. In this direction, a document produced by researchers from the Oswaldo Cruz Foundation, which contains general recommendations regarding mental health care and psychosocial care in times of COVID-19, points out that social isolation can produce an increase in feelings of loneliness, helplessness, and sadness (Melo et al., 2020).

The study by Wang et al. (2020), to understand the levels of psychological impact and anxiety, depression, and stress during the initial stage of the COVID-19 outbreak in the Chinese population, pointed out that: 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% of respondents reported moderate to severe depressive symptoms; 28.8% of respondents reported moderate to severe anxiety symptoms, and 8.1% reported moderate to severe stress levels. It is important to highlight that the study, despite aiming to understand how the general Chinese population was impacted, started with university students and they were encouraged to pass it on to others (in a snowball sampling), leading to a selection bias by having an oversampling of students (52.8% of the total participants). The authors also suggest that the delay in academic progression may have been one of the elements that produced an adverse effect on the mental health of these students.

Therefore, we question the impacts of the current pandemic and the consequent interruption of in-person academic activities for the university population, more specifically on their mental health. This questioning is justified insofar as this population, as well as the general population, was widely affected in the various dimensions of their personal life and, more specifically, was separated from the university context, a space in which significant experiences can be produced.

University life is part of the life cycle of many people, normally occurring between adolescence and youth, generally promoting individual and collective experiences that require sociability strategies from the subject and the adoption of new responsibilities. Also, there is, in general, the experience of new and significant events, such as the distance from the nuclear family, new challenges, conflicts, decisions, choices, and postures that, in addition to outlining aspects of university life, sometimes coincide with entry into adult life, which can cause feelings that are difficult to deal with, such as anguish, discouragement, and anxiety (Assis & Oliveira, 2010; Osse & Costa, 2011).

National studies have focused on the mental health of the university population, both from the perspective of implementing, describing, evaluating, and recommending the improvement of intervention programs in mental health care offered by universities (Assis & Oliveira, 2010; Cerchiari et al., 2005a; Peres et al., 2003) and of mapping psychosocial conditions and estimating the prevalence of minor mental disorders among university students (Osse & Costa, 2011; Cerchiari et al., 2005b), revealing a concern with this part of the population, whose particularity lies in the experiences arising from university life.

Research produced both in the national and international contexts (Duarte et al., 2020; Garvey et al., 2021; Maia & Dias, 2020; Wang et al., 2020) already indicate that the pandemic and its consequences have negative effects on the mental health of university students, sometimes leading them to present high levels of anxiety, depression, and stress, possibly triggered by the delay in academic progression, exposure to excess information about the pandemic scenario and social distancing measures. Gundim et al. (2021) highlight the need to produce research that deepens the understanding of these impacts today.

Given the above, this research aimed to identify the impacts on mental health and on the daily life of students of the undergraduate course in occupational therapy at a federal public university in the face of the scenario of coping with COVID-19.

Methodology

This is an exploratory and descriptive study, with a quantitative-qualitative approach. It is considered that studies of this nature allow a greater understanding of the investigated reality and the research problem (Minayo et al., 2005; Leopardi, 2001).

Participants

Fifty-three students regularly enrolled in the undergraduate course in occupational therapy at a federal public university participated in this research, from 2014 to 2020.

The inclusion criteria of the participants were: undergraduates in occupational therapy regularly enrolled, from the first to the last year of the course, and who agreed to participate in the research.

Students who, although regularly enrolled, did not have the force course, that is, leave of absence, were excluded from the study.

Place

The study was carried out virtually, with students of the undergraduate course in occupational therapy at a federal public university.

Instrument

The instrument used for data collection was a semi-structured questionnaire, prepared by the researchers on the Google Forms platform. It is a self-administered questionnaire, composed of 32 questions, open and closed, organized in two sessions: the first referring to the characterization of the participants and the second aimed at investigating the daily life and mental health of students before and after the COVID-19 pandemic.

Procedures

Ethical questions

The research project was approved by the Ethics Committee for Research on Human Beings of the Federal University of São Carlos (CEP - UFSCar) with opinion number 4,128,864.

The Informed Consent Term (ICF) was sent to the emails of each class of the course at the time of publication of the research and was also fully included in the Google Forms questionnaire.

Validation of the data collection instrument and pilot study

After being prepared by the researchers, the questionnaire was sent to be evaluated by expert judges in the area, as suggested by Manzini (2003). Their suggestions and contributions were incorporated by the researchers and, later, the instrument was submitted to a pilot study. The pilot study was carried out with three undergraduates from different periods of the occupational therapy course at a federal public university, aiming to make the last adjustments to the instrument before the beginning of data collection. Based on the answers presented by these students, the instrument underwent the last adjustments and was finalized.

Data collection

Initially, we consulted the coordination of the undergraduate course in occupational therapy, and we identified 227 regularly enrolled students. Of these 227, five students were excluded because they did not meet all the inclusion criteria. Therefore, 222 students were eligible and, therefore, were invited to participate in the research.

Contact with the participants took place by sending an invitation to the e-mail addresses of the classes. Another vehicle of dissemination adopted was the social networks of the academic center of occupational therapy, as well as the representatives of each class of the occupational therapy course, was contacted, who volunteered to disseminate the research with their respective classes through groups in a message application.

Data collection took place from July to August 2020, after different dissemination strategies and invitations. At the end of that period, 53 responses were obtained, which corresponds to 23.87% of the total sample.

Data analysis

Quantitative data were analyzed using descriptive statistics and presented using figures and tables. For the open questions, the technique of Categorical Analysis was used, one of the techniques contained in the Content Analysis proposed by Bardin (2011).

This technique adopts the entire text in the analysis, having a classification and quantification screening, according to the frequency of presence or absence of meaning items (Bardin, 2008). That is, for each open question, all the answers obtained were gathered and enumerated, and, subsequently, based on the reading and identification of common elements, a category was created. For each category, examples were recorded, as well as the number of citations, based on the count of these common elements.

Results and Discussion

General information about participants

Fifty-three undergraduate students in occupational therapy at a federal public university participated in this research, which corresponds to 23.87% of the total number of students initially identified as potential participants.

Regarding gender, 43 (81%) of the 53 participants answer that they were female, 7 (13%) were cisgender women, 2 (4%) male, and 1 (2%) as “other”. Regarding age, 6 (11%) participants are between 17 and 19 years old, 20 (38%) are between 20 and 22 years old, 21 (40%) are between 23 and 25 years old, 2 (4%) are between 26 and 28 years old and 4 (7%) are between 29 and 35 years old. Regarding race/ethnicity, of the 53 participants, 38 (72%) declared to be white, 2 (4%) said they were black, 8 (15%) said they were brown, 4 (7%) said they were Asian and 1 (2%) was classified in the “others” category. Regarding marital status, almost all participants – 50 (94.3%) – declared to be “single”.

A significant percentage of the participants correspond to the “older veterans” (57% of the total sample), that is, who entered graduation in 2014, 2015, and 2016, and who are possibly heading towards the end of the course. Another category that deserves to be highlighted, depending on the number of respondents, is the category of “entry students” (13%), who started their graduation in 2020.

Ariño & Bardagi (2018) point out that an undergraduate course can be divided into three major moments: the initial one (in which there is a migration from high school to higher education); the medium (in which contact with professional practice begins through internships); and the end (characterized by the end of the student role and entry into the job market) so that each of these moments is composed of different demands, which can influence the health profile of students at each stage.

As an example, the study by Brandtner & Bardagi (2009), carried out with 200 university students distributed among the Physical Education, Literature, Food Engineering, Psychology, and Administration courses indicated that, in general, anxiety rates were higher than depression among the total number of participants. However, beginning-of-course students had significantly higher rates of depression than final-year students. The research by Jardim et al. (2020), carried out with 410 university students from health courses, revealed no significant difference between freshmen and seniors in terms of the levels of depression, stress, and anxiety identified. Finally, the study by Silva et al. (2020), carried out with medical students from a university, revealed, among its results, that the study participants had a high rate of minor mental disorders, although there were no significant differences in general mental health between participants at different periods of the course.

Despite the methodological particularities and the different indications present in the aforementioned studies, in addition to the fact that the period in which the students are in the undergraduate course cannot be placed as a determining factor for the occurrence or not of psychic suffering, we verified in the results of all of them predictive factors or the existence of psychological distress among university students. There is also an indication of the need for further studies that investigate the mental health of university students, as well as the role of the university and its possibilities to assist in the care and promotion of the mental health of this population (Brandtner & Bardagi, 2009; Castro, 2017; Jardim et al., 2020; Silva et al., 2020). This is also an object of analysis and concern in this study, especially due to the advent of the pandemic and its impacts on the life and mental health of students.

More specific aspects regarding the mental health status of students and the activities that made up their daily lives before the COVID-19 pandemic and its consequences will be discussed in the following section.

Participants' mental health and daily activities before the COVID-19 pandemic

Figure 1 shows the students' perceptions of their mental health before the pandemic scenario.

Figure 1
Representative graph of students' Mental Health before the COVID-19 pandemic. Source: Prepared by the authors.

The analysis of Figure 1 enables us to identify that, before the COVID-19 pandemic and its consequences, 36 (68%) students either had no previous problems or did not have problems that interfered/impacted their lives significantly. However, 13 (24%) already had mental health issues that impacted their lives (significantly or not) and 4 (8%) already had a diagnosis of mental disorder that interfered with their life and compliance with mandatory activities. The indices found in this study draw attention and perhaps move towards the finding made by Constantinidis & Matsukura (2021), that the identification of the increase in the prevalence of psychological distress among university students in recent years has led to an increase in studies dedicated to investigating on the mental health of students of occupational therapy courses. We cannot say that these previous issues related to mental health highlighted by the students are provoked or accentuated by the condition of being a university student. However, attending an undergraduate degree generates new demands, such as the need to carry out long hours of study in which students are forced to adapt to be able to face such demands. This process, which requires a behavioral repertoire, can be stressful and directly impact the mental health of students, especially those who did not previously have this baggage of skills and competences (Ariño & Bardagi, 2018) to deal with the demands of the context and with the challenges imposed. Furthermore, according to the 2019 report by the National Forum of Pro-Rectors of Community and Student Affairs (FONAPRACE), in a sample of 424,128 undergraduate students from 63 Brazilian federal universities, the percentage of participants who signaled some emotional difficulty (such as anxiety, persistent sadness, fear/panic, insomnia or significant sleep changes, feelings of helplessness/despair/hopelessness, discouragement, unwillingness to do things, feelings of loneliness and suicidal thoughts) in the last 12 months was 83.5%, and anxiety was reported by 6 out of 10 students (Associação Nacional dos Dirigentes das Instituições Federais de Ensino Superior, 2019). Thus, the occurrence of some type of psychic suffering in university students is already known in the literature, even in conditions before the pandemic, as shown in the data in Figure 1. However, in addition to the perception of their mental health, to understand how the students were before the advent of the pandemic and its consequences, it is important to know how their routine was composed to assess whether and how the pandemic impacted them.

Table 1 shows an overview of which activities made up the daily lives of students before the pandemic and its consequences.

Table 1
Table of Activities carried out by students before the COVID-19 pandemic.

Category	Examples	Citations (n)
Academic activities	- Undergraduate classes	50
	- Outreach and scientific initiation projects
	- Internship
Socialization	- Moments with family, friends, and lovers	34
	- Living in the dorms
	- Parties in general with friends
Physical activities, sports, and gym	- Go to the gym	31
	- Hiking/running
	- Regular practice of some sport
Instrumental activities of daily living	- Preparing meals	19
	- Domestic cleaning
	- Beware of animals
Leisure activities	- Leisure activities (unspecified)	14
	- Reading books
	- General tours
Work	- Informal work	9
	- Clinic service

• Source: Prepared by the authors.

Table 1 shows that the participants performed a wide range of activities, which crossed the academic, social, sports, spiritual, leisure, work, etc. The expressively mentioned categories were academic, social activities (in which collective activities were necessarily considered), and physical activities. In addition to the activities in Table 1 ¹, other activities were rarely mentioned – travel (8 citations), religious activities (6 citations), integrative and complementary practices (5 citations), and extracurricular activities (4 citations).

The wide universe of activities, represented in Table 1, carried out by the participants of the present research evokes a discussion around the importance of doings and activities for human existence, which implies the constitution of daily life and that certainly produces reverberations in mental health.

Lima's (2019) notes contribute to this discussion, expanding it, since for the author

Human beings are those beings of potency, who can do and not do, succeed and fail, lose and find themselves. Its uniqueness comes into existence and appears in the public dimension of the common world in those activities that only exist in mere performance and that are conditioned to the presence of others. The who that appears in action and discourse appears in its singularity and matters above all because its existence is potency (Lima, 2019, p. 124, author's emphasis).

At a first glance, everyday life can indicate how each one relates to their routine, their habits, with their daily tasks and events (Maximino & Tedesco, 2016), but it expands subjectively when it comes to thinking about everyday life, which is presents, as a result of the interaction between the subject's external and psychic reality, the web of social relationships, trivial self-care activities, solidarity actions (Galheigo, 2003). In this sense, it is possible to say that it is in everyday life that the human being shows as a whole, putting his ideas, passions, feelings, and intellectual abilities into motion (Heller, 2000).

Thus, life is woven in process, based on fragments of experiences, feelings, and memories. Every day, this kind of plot on which it rests, but also happens dynamically, the life of each one is what makes it possible to “access experience, the real, the imaginary, memory, dreams, feelings, needs and affections” (Galheigo, 2020, p. 8).

We can suggest that changes and alterations in the structure that represents the daily life of each one can impact well-being, well-living, and, consequently, on mental health.

The following section gathers information about general changes caused by the COVID-19 pandemic and its consequences in the daily lives of students.

COVID-19 pandemic and its impacts on the different dimensions of students' lives

The students of the undergraduate course in occupational therapy, due to organization and institutional decision, until the moment of data collection for this research, continued with all academic activities suspended, both in the face-to-face and in the distance modality. That is, about this department of these subjects' lives - everyday academic activities, social role, social relationships, and other everyday activities organized around academic life -, it is possible to suggest that it was significantly changed since it became “suspended” in the lives of all these students.

Of the 53 research participants, 16 (30%) declared to belong to the city in which the university is located, and these remained in the city. However, 37 (70%) students come from other cities; of these, only 8 (15%) decided to stay in the city where the university is located, and they indicated that they were with classmates, partners, or family members.

The second most cited factor (3 citations) by these students who justified their stay in the city where the university is located was protecting family members and people close to the transmission of COVID-19. They understood that experiencing social distancing away from relatives who fall into the risk group would be more protective for them, as we can see in the following examples:

I live with three people from the risk group, so I preferred to quarantine in [name of the city where the university is located] (E44).

I preferred not to take risks not even for my family members and my girlfriend at risk (E32).

The aforementioned excerpts seem to correspond to the understanding of Schmidt et al. (2020a) about the role of social distancing, that is, that the assumption of this strategy by people must transcend the field of obligations and impositions and present as an act of altruism and a real commitment to individual and collective care. They also state that attitudes like this contribute to increasing trust and adherence to health recommendations issued by public health authorities.

The 29 students who chose to return to their hometown, where they are with family and partners, highlighted “financial issues” as the main factor in their return (with 11 citations). The justifications indicate that staying in the city where the university is located would be financially unfeasible, since it would bring additional expenses with rent, food, internet, etc.

It is necessary to question and reflect on the possible impacts and their quality on the life of students - mainly in the medium and long term - due to such and sudden changes, especially those that implied the return of students to the city of origin, with the return of residence and/or term of dorms in the city where the university is located. Is it like ending a cycle without having completed it? Is it like suspending a life process/project without prior elaboration, but having to resume it in the uncertainty of when and how? Certainly, this scenario of uncertainties, abrupt ruptures, and absences will give the university a key role in mapping and monitoring the conditions of these students, in offering assistance, often of a material/financial nature, so that they can return and resume their face-to-face activities when possible. It is about bringing to the arena of institutional discussions around the policy of student permanence, what will be the innovations and concrete advances necessary to guarantee return and permanence that are, in fact, welcoming, careful, and enablers of continuity.

The second most cited category (with 10 citations) corresponds to the desire to avoid being alone in a context of distancing, as the following statements illustrate:

[...] being a freshman, I never lived alone and that would happen if I stayed, after all my apartment partner also came back. I don't think it would be ideal to go through this alone, especially without being able to see anyone due to social distancing (E50).

I live in a dorm and all the girls came back, so as not to be alone in the house, I chose to go back in addition to having more support in my home for this current situation (E51).

It is interesting to note that, in addition to the desire not to be alone, the student indicated that, in the city of origin, she would have more support to go through this situation (of a pandemic and social distance), allowing the inference that this scenario can impose challenges and difficulties that require support, company, sharing and support from close people, who represent a bond to deal with the situation.

Also, with 4 citations, it is important to highlight the category “family care”, in which the students indicate that their return to the city of origin was important to assist their relatives, as the examples illustrate:

[...] with the increase in cases in Brazil, I became very worried and afraid, wanting to be with my parents and family, if they needed help, I would be close by (E4).

My parents are a risk group and I am taking on activities that require leaving home (E29).

Therefore, having support and being supported were motivators that influenced students to return to their hometown. Furthermore, a document produced and published by the Pan American Organization containing psychosocial and mental health considerations dedicated to the Covid-19 pandemic scenario suggests that self-care, as well as the availability to support and care for others, produces benefits for those who receive support and care for those who offer it (Organização Pan-Americana da Saúde, 2020), revealing that it is an action with the protective potential for mental health.

Whether or not they remain in the city where the university is located, the student's daily activities have been altered in some way, whether in the condition that they need to be interrupted or adapted, following the recommendations arising from social distancing. Table 2 below depicts which activities were changed.

Table 2
Table of Activities that were changed during the pandemic.

Categories	Examples	Citations
Academic activities	- Undergraduate classes	50
	- Outreach and scientific initiation projects
	- Internship
Socialization	- Moments with family, friends, and lovers	33
	- Parties in general with friends
Physical activities, sports, and gym	- Go to the gym	30
	- Hiking/running
	- Regular practice of some sport
Instrumental activities of daily living	- Leisure activities (unspecified)	12
	- General tours
	- Visit cultural and gastronomic spaces
Leisure activities	- Work in general	8

• Source: Prepared by the authors.

When considering the data presented in Table 1 and relating them to the results presented in Table 2, we can suggest that practically all activities that made up the daily lives of students before the COVID-19 pandemic were altered in some way with its advent.

Table 2 also shows that the socialization category was the second most cited among the daily activities that changed, having been suspended or adapted. It is questioned about the magnitude of this impact for the students participating in the present research and its repercussion for the well-being and quality of life.

Regular classes, internships, and going to the gym were interrupted, as well as many meetings with family and friends, when not adapted for virtual contact. The following statements illustrate this reality:

I don't go to university anymore, I stopped doing physical activity often [...] I don't see my friends anymore, I don't see my grandparents anymore since the isolation started, nor contact with my family who don't live in the same city as me. (E9).

Classes, leaving the house and spending time with friends were interrupted and I usually chat with some people by text, with others I barely have contact now [...]. The ic and the project continue remotely and were adapted (E11).

As we can see in the examples above, some scientific initiations and academic projects were continued remotely. Amid the initiatives to try to guarantee some maintenance of academic activities, Teixeira & Dahl (2020) pointed out in a study that, among the possible support strategies between professors and students adopted by an undergraduate course in occupational therapy, the adaptation of some academic activities for the remote modality it was fundamental to help students in the reorganization of their routines.

The next section brings together results that deal more specifically with aspects related to the mental health of participants in times of pandemic and social distancing.

Impacts on the mental health of students

When asked about the occurrence or not of mental health impacts as a result of the pandemic and the consequent suspension of regular activities at the university, almost all the participants (94%, which corresponds to 50 students) gave an affirmative answer. Thus, the present research indicates that the COVID-19 pandemic and its consequences, such as the interruption of academic activities, were configured as an impact and risk factor for the mental health of occupational therapy students, since, before the pandemic scenario, 68% of students either had no previous mental health-related issues or the existing ones did not significantly interfere/impact their lives. This result matches the findings of the integrative literature review carried out by Gundim et al. (2021), which points out, based on the consultation of seven studies, the occurrence of psychological distress among university students, who presented stress, feelings of incapacity in the face of isolation, concern with preventive care, fear of losing relatives and friends, concern about the country's economic situation, signs of anxiety and depression, as well as headaches, irritation, isolation, loss of desire to carry out activities, anguish and even eating disorders. Additionally, the research developed by Maia & Dias (2020), whose objective was to explore the levels of anxiety, depression, and stress in Portuguese university students in the typical period (in 2018 and 2019) and compare them with the pandemic period (March 2020), confirmed a significant increase in anxiety, depression, and stress among participants in the pandemic period, compared to results collected in previous years. The researchers of that research suggest that information about the global situation and the confinement measures may have had harmful effects on the mental health of these students, although it cannot be said that the only responsible factor was the advent of the pandemic. Among the students of the present research who claimed to have observed their impacted mental health, we found the following manifestations they perceived in themselves: discouragement and frequent lack of motivation; cry; anxiety; fear; irritation/nervousness; concern; hopelessness about the present and future; symptoms such as headache, stomach pain, lack/excessive appetite or sleep, fatigue, and frequent crying. The questionnaire allowed marking more than one option.

Figure 2 below shows the number of markings for each item mentioned above.

Figure 2
How do you perceive this impact on yourself?. Source: Prepared by the authors.

The results in Figure 2 show that students who indicated that they had suffered an impact on their mental health observed anxiety (92%), discouragement and demotivation (80%), irritation/nervousness (76%), and concern (76%). However, hopelessness, fear, and physical symptoms also showed a significant percentage. The only manifestation scored by less than 50% of impacted participants was frequent crying.

The 50 students in the present research who scored having been impacted were asked about the intensity of the perceived impact on their mental health, that is, whether the intensity of the impact was “small”, “medium” or “large”, based on their perception. The “medium” and “large” impact levels were scored equally, with 18 respondents each, totaling 72% of the sample. Thus, those with little impact represent only 28% of the sample, with 14 respondents.

For the three levels of impact, the category “individual changes in mood” was the most cited, with anxiety being widely reported by students, as shown in Figure 2, corroborating recent findings from studies in the area.

In the direction of the findings of the present research, the study carried out by Garvey et al. (2021), carried out with 198 undergraduate students from a Spanish university, found that about 18.7% of university students suffered from severe anxiety and 70.2% suffered from mild or moderate anxiety during the confinement period. The study developed by Cao et al. (2020) with 7143 undergraduates from a Chinese college indicated that 24.9% of university students were suffering from mild and moderate anxiety during the period of confinement.

Participants in this study reported feeling anxious as a result of uncertainties regarding the completion of the course, constant news and information about the pandemic, concern about the exposure of family members to the virus, financial issues (such as loss of financial freedom and dependence on parents' income), academic activities, among other factors. Some excerpts may illustrate these statements:

[...] the family sees a lot of news in the newspaper about the coronavirus and other things, which causes me a lot of anxiety since I cannot distance myself from such information (E24).

Returning to my parents' house, losing my freedom and independence, and knowing that it will take me longer than planned to graduate, earn my money and not depend on them anymore, causes me a lot of anxiety. I have had several crises since the beginning of the pandemic (E36).

The news about the pandemic and the concern about the exposure of my family members who work and do not strictly follow the recommendations to avoid contagion make me anxious (E34).

The study developed by Teixeira & Dahl (2020) also identified, among students of an undergraduate course in occupational therapy, that, in addition to the difficulties and limits of access to virtual resources imposed by the pandemic scenario, they were also deeply affected by the disorganization of the routine, the insecurity, and uncertainties regarding the current scenario, as well as the concern and fear regarding the illness of loved ones. Regarding the latter – concern, and fear for loved ones – also identified in the present research, it is worth noting that studies and institutional documents have indicated that the constant concern and fear with the possibility of family members contracting COVID-19 or even dying as a result of this has revealed reactions that can compromise the well-being and mental health of the population (Melo et al., 2020; Wang et al., 2020). However, reactions of fear, worry, stress, among other reactions, that emerge as a result of the pandemic scenario are expected, that is, it is normal to struggle and suffer in different ways in the face of so many changes and challenges that can be experienced in this scenario (Whitaker, 2020). Thus, it is always necessary to carefully assess and consider what is normal and expected and what is classified as a picture of intense psychological distress that will require professional support and other care strategies.

Importa observar que, no presente estudo, existem outras similaridades que merecem destaque entre os três níveis de impacto: para os três, a segunda categoria mais citada é a de “distanciamento social e suas implicações”, a qual retrata a falta que os estudantes sentem dos amigos, da família, e dos espaços de convivência (como a universidade); e a terceira categoria se refere à “interrupção das atividades acadêmicas”.

It is important to note that, in the present study, other similarities deserve to be highlighted between the three levels of impact: for all three, the second most cited category is “social distancing and its implications”, which portrays the lack that students feel. friends, family, and living spaces (such as the university); and the third category refers to the “interruption of academic activities”.

Here are some statements made by students:

I feel lonely, I miss socializing, I miss going to the gym, which is very good for my body (E20).

The suspension of activities at the university had a great impact on my mental health because I was in my final year of graduation, with plans for external internships in the next semester, as well as plans to do a residency. With the pandemic, this whole process was uncertain, including how and when I will be graduated. In addition, college and my daily activities [...] gave me a sense of stability and routine; due to this shutdown, I miss it a lot, which causes me a lot of psychic suffering (anxiety) (E40).

Regarding the impacts from social distancing and, consequently, from the social network of the participants in this research, it is important to highlight the findings of the study developed by Barroso et al. (2019), whose objective was to evaluate loneliness and depression in university students, verifying their relationship with habits, course characteristics, and social support. The researchers were able to identify that having leisure activities inside and outside the home, having friends and going out with them, having a religious belief, and practicing physical activity were associated with lower levels of loneliness and depression. Therefore, such habits proved to be effective in promoting well-being and significant in shaping the students' daily lives.

It is important to note that the daily life of the students in the present research was composed, primarily, according to Table 1, of academic and socialization activities, so that Table 2 confirms that these have been altered in some way, either by being interrupted (such as graduation courses) or adaptation (such as meetings with friends). Thus, when considering that the second and third most cited categories of the three levels of impact refer to the implications of social distancing and the interruption of academic activities, it can be inferred that such changes contributed significantly to the students feeling their impacted mental health.

Therefore, the findings of this study are in line with those already identified in the literature, that is, that factors such as instability in family income, excessive or false news, delays in academic progression, separation from friends, and disruption of academic routine are factors that contribute to anxiety and psychological distress among students (Cao et al., 2020; Schmidt et al., 2020b; Wang et al., 2020).

Students who claimed to have had their mental health impacted due to the pandemic context were asked about the strategy(ies) adopted to elaborate on the difficulties experienced. It was allowed to tick more than one item in the questionnaire, which presented different strategies, such as including pleasurable activities in the routine, seeking professional help, practicing religious activities, etc. Figure 3 below shows the number of tags received by each strategy:

Figure 3
Graphic representing the coping strategies adopted by students. Source: Prepared by the authors.

As we can see in Figure 3, the most used strategies were the inclusion of pleasurable activities that generate well-being, as well as the inclusion of courses and projects of interest. There was also a search for emotional support from friends and family, even if virtually. Thus, within the “bubbles of distance”, according to Amorim (2020), people sought to reinvent, breaking with their normal routine and adopting patterns more consistent with the pandemic scenario.

The discussion around the strategies for coping with the difficulties experienced in this context is justified insofar as the psychic suffering experienced by society, and by the students, as a result of the pandemic, its consequences, and containment strategies, tend to remain in the post-pandemic period in the short, medium and long term (Schmidt et al., 2020b; Brooks et al., 2020), making it necessary to adopt prevention and harm reduction strategies, encouraging the collaboration of several health and education institutions (Maia & Dias, 2020).

Final Considerations

The present research aimed to identify the impacts on mental health and daily life of undergraduate students in occupational therapy at a federal public university coping with the COVID-19 scenario, having been achieved in its entirety.

The main results found show that the advent of the pandemic, and the consequent adoption of measures to combat social distance, produced significant changes in the daily lives of students, as well as intensified pre-existing psychic suffering or inaugurated them in this scenario. The impact produced by the suspension of academic activities was also evidenced, evoking a discussion around the importance of the university discussing support and assistance strategies for the return to activities of these students, as well as ways to ensure student permanence.

One of the limitations of this research is that it was carried out only with students of an undergraduate course in occupational therapy, so other studies in this direction, covering occupational therapy courses from other institutions, will certainly contribute greatly to the understanding of this scenario in the national context, and may even expand this contribution towards the identification of possible actions to prevent and promote the mental health of students, encouraging their implementation both in the individual and collective spheres.

This research was carried out throughout 2020 when the pandemic scenario was inaugurated, its first measures to face and identification of the first impacts on the population. Faced with the current scenario, where the pandemic has lasted for more than a year, it is important to investigate how and what strategies to deal with students, but also the general population has adopted to deal with the persistent and permanent challenges. Thus, we point to the need and importance of investing in research that deepens the understanding of these impacts and the possible coping strategies adopted.

Ethical Procedures

All ethical procedures were met, and the research was approved by the Ethics Committee for Research on Human Beings of the Federal University of São Carlos (CEP - UFSCar) with opinion number 4,128,864.

• 1
  It is pointed out that, in some of the figures, not all the generated categories will be exemplified, only the most cited ones, since a very high number of categories was found.
• How to cite: Morato, G. G., Fernandes, A. D. S. A., & Santos, A. P. N. (2022). Mental health and everyday life of occupational therapy students facing Covid-19: possible impacts and repercussions. Cadernos Brasileiros de Terapia Ocupacional, 30, e3035. https://doi.org/10.1590/2526-8910.ctoAO23003035

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Edited by

Section editor

Prof. Dr. Milton Carlos Mariotti

Publication Dates

• Publication in this collection
  27 Apr 2022
• Date of issue
  2022

History

• Received
  02 June 2021
• Reviewed
  26 Oct 2021
• Reviewed
  09 Nov 2021
• Accepted
  23 Dec 2021