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 effects¹, causing worldwide changes at personal, professional and social levels². 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 health³.

Moreover, sanitary measures were taken to mitigate contamination, particularly, the use of face masks and social distancing⁴. 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 quality⁵. 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 2022⁶. 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 life⁷.

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 contexts^8),(9. 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 model¹⁰, 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 classes¹¹.

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 ones¹². A previous study¹ 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 Disorders¹³, 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 population¹⁴. 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 them¹⁵.

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

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.

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).

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.

Source: The authors.

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).

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).

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 severe²¹. 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 reported²², 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 2021²³, 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 pandemic²⁴. 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 suffering²³.

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 students¹¹, 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 diseases²⁵. Similarly, it is possible that social isolation has increased the experience of loneliness²⁶.

Additionally, psychosocial stressors may also have contributed to the intensification of mental distress during the pandemic²⁵, 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 countries²⁷. 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 abuse²⁸. Therefore, the increase in alcohol consumption, on the one hand, emerges as part of a maladjusted coping strategy¹⁰, as a result of the stressors concerning the pandemic; and, on the other hand, it aggravates the psychopathological symptoms²⁹ 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%³⁰. 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 studies³¹. 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 PTSD³², 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 fear³³.

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 aerosols³⁴. 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 risk^35),(36. 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 PTSD³⁷. 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 changes³⁸. Added to these factors, there was the interruption of plans and the uncertainty regarding their future in the professional career⁷.

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 others³⁹, 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 ill²⁴.

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.