Mental health and coping strategies in graduate students in the COVID-19 pandemic

Objective: to verify the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19). Method: an electronic cross-sectional and correlational survey was conducted with 331 Brazilian graduate students, aged 20-64 years old, who answered an online form containing a sociodemographic data questionnaire, a coping strategies scale, and the DASS-21 scale. Descriptive analysis, Mann-Whitney U or Kruskal-Wallis tests, and Spearman’s correlation were performed. Results: the main results indicated that maintaining work and study routines, as well as a religious practice, is correlated with lower scores of depression, anxiety, and stress symptoms, as well as with coping strategies that can act as protective factors. Conclusion: the new coronavirus pandemic has strained public health and increased the need for studies aimed at understanding the impact of the event on the mental health of the population. It is suggested that employment and religiousness should be considered in interventions with graduate students.


Introduction
In relation to mental health, the population of university students is being more researched, representing an increasing trend since the COVID-19 pandemic (1)(2)(3)(4) . The expressive levels of psychopathological symptoms found in the contemporary world are not the only scientific interest in these students. The way in which Higher Education Institutions (HEIs) have been organized is questioned, considering hospitality to the students as one of the guidelines to offer more humanized academic education, in an attempt to go beyond the mere focus on the cognitive aspects and practical training of future professionals, allowing the construction of strategies for higher education quality, in which the emotional conditions are taken into account for this academic training to be successful (5) .
Research in mental health in Brazilian and foreign universities has prioritized undergraduate students, with a reduced number of studies depicting the reality of graduate students, causing certain invisibility of this population (6) . Mental health in graduate students has been an urgent issue, although less researched. In recent years, graduate programs have undergone important changes regarding their organization, incentives for the growing production of innovative knowledge, and communication possibilities with research studies and researchers from abroad, expanding collaboration networks and, consequently, the scientific and social impact of this production (7) .
Despite these challenges, which consider the need to innovate and internationalize graduate education, the mental health of these students, often neglected by graduate programs, should be discussed. Elements that must be problematized in this discussion are the study, work and permanence at the University conditions throughout graduate education. This discussion must consider the socio-economic conditions of these graduates, the instability of graduate programs in the Brazilian political scenario, and the insertion into the job market after the pandemic. Such combined elements should be compared to an expanded approach to mental health in graduate education, retrieving the need to explore the strategies by the students to face these markers, and unequivocally leading us to the concept of coping (1,8) .
Coping can be understood as the association of strategies that people use as a way to eliminate, reduce or manage stressful events. Such strategies can be focused on the problem or on emotion; the former emphasizing the cause of stress and changing its relation with it, and the latter focusing on the emotional response and adaptation to the event (8) . Thus, one of the resulting needs refers to how graduate students have adapted to the challenges imposed by the COVID-19 pandemic, with resources and strategies not only to maintain teaching and research activities, but also for mental health in this period of strong emotional distress.
This interest reveals the need not only to know the psychopathological symptoms of this group, but their conditions to face the challenges imposed. A number of studies conducted with different student populations have highlighted resources such as mood, distraction, and also resilience capability (9)(10)(11)(12) . These strategies are focused on both emotional aspects and problem solving. However, the associations between the production of these resources and the emotional conditions of graduate students are still unclear in the scientific literature (3,10,12) .
Cultural contexts can exert an impact on these strategies, as in the case of Brazilian students (10) . Knowing these scenarios can make educational and mental health strategies aimed at these students even more effective in a context of transit through the pandemic, which reinforces the relevance of this research. The interest in this study arose from the need to know if the social distancing policies, launched in Brazil from March 2020 and imposed during the pandemic, had repercussions on the mental health of these students.
From this panorama, this study focuses on possible coping strategies produced in response to COVID-19 and on the recognition of the psychological needs of graduate students in the pandemic. Thus, it aims at verifying the relation of depression, anxiety, and stress symptoms with coping strategies in graduate students in the context of the new coronavirus pandemic (COVID-19).

Study design
An electronic cross-sectional and correlational survey was conducted.

Scope
Students enrolled in graduate courses during the first semester of 2020 were eligible to participate in this study. These students should be enrolled and at any stage of their graduate studies, without restrictions on the educational institution or training or research area.

Data-collection instruments
A sociodemographic data sheet, specifically designed for this study with questions related to the characterization of the participants, such as gender, age, schooling level and information on the degree of social distancing, COVID-19 symptoms, testing and results, as well as socioeconomic, labor and educational situation.

Data collection
Online data collection using the Google Forms tool.
The invitation containing the link to the form was sent via e-mail to several Brazilian Higher Education Institutions.
Invitations were also sent to groups of graduate students

Data analysis
Initially, normality tests (Kolmogorov-Smirnov and Shapiro-Wilk) were performed, which showed that the data regarding the depression, anxiety and stress symptoms and coping strategies variables did not present normal distribution (p < 0.05) and, therefore, non-parametric statistics should be employed. Subsequently, descriptive analysis (frequency, mean, standard deviation) were performed to investigate the graduate students' profiles and the characteristics related to social distancing and COVID-19. Afterward, the Mann-Whitney U test was performed to verify differences in depression, anxiety and stress symptoms and coping strategies employed    Regarding psychopathological symptoms, graduate  Table 3). who do not need to go out of their house to work and those who do need to do so, with the former having higher stress symptoms than the latter (U = 6,009.500, z= -1.991, p = 0.05), with small effect size (r = -0.11).
The graduate students who practice some type of religion had lower scores in depression (U = 9,912.000, z = There were statistically significant differences in the depression scores (H(2) = 13.67, p = 0.001) among students by study situation, with the group that "does not continue studying" having higher depression scores than those that "continue studying" (z = -3.073, p = 0.006, r = 0.17) and those who "study part-time" (z = -2.555, p = 0.05, r = 0.14). Regarding the differences in relation to the coping strategies employed, there were statistically significant differences in Factor 7 -Problem Solving, (H(2) = 12.96, p = 0.02) with a higher score in the group of graduates who "continue studying" than in those who "do not continue studying" (z = 3.112, p = 0.002), with small size effect (r = 0.17).
There were statistically significant differences by type of institution in which the graduates study, in the depression scores (H(2) = 8.37, p = 0.02) between the public and private HEI groups (z = 2.882, p = 0.004), with the former presenting the highest score in these symptoms, with small effect size (r = 0.16). In addition, there were statistically significant differences in the anxiety symptoms scores (H(2) = 6.97, p = 0.03) between graduate students from public and private institutions, the former with higher scores than the latter (z = 2.638, p = 0.008) and with small effect size (r = 0.14). There were no statistically significant differences across groups from public, private, and community HEIs concerning the coping strategies employed (p > 0.05).
Analyses were performed to compare depression, anxiety and stress symptoms and the coping strategies    (20)(21) . Potentially stressful and anxiogenic situations can trigger escape-avoidance in response to these symptoms. Another fact that corroborates the scientific literature refers to the greater exposure of women to stress symptoms (22) . This discussion cannot be separated from a gender perspective that considers the role of women in our society. In the context of social distancing, women tend to assume different activities more intensely.
In the case of female graduate students, these activities can very probably involve not only continuing education but also caring for the home, children, and other family members, in a situation aggravated by the pandemic. This could also explain that these women tend to use escape-avoidance strategies more intensely, in a context that does not provide conditions to balance dedication to the various activities demanded during the pandemic, with the collaboration of other family members around them. This should also be considered since students who are isolated at their homes tend to manifest more stress symptoms.
Concerning the coping strategies employed, there was greater positive reappraisal, followed by a lesser level in accepting responsibility. Regarding this last factor, it can be understood that the situation of isolation is an important marker in this context. Concerning household activities, the "accepting responsibility" strategy can be related to the division of tasks and to the very effect of greater proximity to family members who live in the same house.
Regarding graduate studies, the instability introduced by the pandemic interrupted normal academic processes such as in-person data collection, as well as it postponed qualification and defense exam dates,

Discussion
The first aspect that can be considered from the results is the difference between graduate students who hold jobs and those who do not, from a perspective that points out that those who work have fewer stress symptoms, greater social support, and a higher problem solving level. It is possible to understand this result considering that employment can be a factor that reduces anxiety in the face of the changes imposed by the pandemic (17) , especially in this group.
Instability in the face of the pandemic (18) can trigger great emotional distress derived from practical aspects; for example, the possibility of resuming data collections and interventional studies, which were suspended by the pandemic. Therefore, employment could reduce stress precisely because it is a concrete dimension of employability and a context of greater stability than that represented exclusively by graduate studies. Considering the importance of social interactions in this context, the possibility of maintaining some social contacts at work also suggests greater social support compared to the more strictly isolated graduate student (6) .
In a scenario of instability in graduate education, the pandemic can accentuate some practical aspects that already concerned the students. Aspects such as maintaining scholarships or not, the deadlines for credit payments, the possible extension of deadlines, and even the opportunities of future employment, tend to impact on mental health. The pandemic has affected higher education. Situations such as layoffs, suspension of public tenders, and even availability of resources to maintain investments in graduate education indicate an uncertain future for those who aspire to an academic career (6) . This scenario can be more stressful for a student who is not yet employed. As observed in the sample, the response to this scenario is revealed in the greater use of escapeavoidance strategies, expanding the distance between the graduate student and the job market. In the context of the pandemic, these uncertainties also affect the possibility From the panorama discussed in this study, the highlights are summarized as follows: focus on possible coping strategies produced in response to COVID-19; maintaining a study routine is correlated with lower scores of mental disorders; religious practice is correlated with lower scores of mental disorders; entering the labor market and religiousness should be protective factors; and recognition of the psychological needs of graduate students in the pandemic.

Conclusion
Our findings pointed out that maintaining a work and study routine, as well as religiousness, can act as protective factors for mental health during the pandemic.
Holding a job can be related to the perception of greater material security, as well as providing contact with people who serve as social support, the most frequent coping strategy in graduate students who work. Religiousness can act as a protective factor by providing resources for the individual to distance from the problem and to reevaluate it in a protective manner. One of the most frequently given pieces of advice to mitigate the impact of the pandemic on mental health is not to consume too much current information, looking for activities that can help "disconnect" for a while. Thus, religious practice can provide moments of withdrawal from the problem, allowing it to be reframed, in some way. www.eerp.usp.br/rlae