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A Rapid Assessment of Depressive and Anxious Symptoms among University Students during the COVID-19 Public Health Emergency: A Repeated Cross-Sectional Analysis

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Title: A Rapid Assessment of Depressive and Anxious Symptoms among University Students during the COVID-19 Public Health Emergency: A Repeated Cross-Sectional Analysis
Language: English
Authors: Sara H. Goodman, Bernadette Boden-Albala, Emily Drum, Nessa Ryan, Brooke Gibbs, Desiree Gutierrez, Miryha Gould Runnerstrom, Jeffrey J. Wing
Source: Journal of American College Health. 2025 73(4):1711-1720.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Tests/Questionnaires
Education Level: Higher Education
Postsecondary Education
Descriptors: Depression (Psychology), Anxiety, College Students, COVID-19, Pandemics, Correlation, Student Characteristics, Mental Health, Health Behavior, Social Support Groups, Social Bias, Resistance (Psychology), Stress Variables, Minority Serving Institutions, Student Diversity, Racial Differences, Ethnicity
DOI: 10.1080/07448481.2024.2400114
ISSN: 0744-8481
1940-3208
Abstract: Objectives: To identify potential associations between student characteristics and mental health symptoms during the early parts of the pandemic. Participants: 3,883 students at a large public university on the West Coast of the United States. Methods: We conducted a repeated cross-sectional survey to assess health-protective behaviors, mental health, social support, and stigma resistance. The survey was administered in April 2020 and again in November/December 2020. Odds of mental health symptoms were estimated using multinomial logistic regression. Results: 39% of respondents reported anxious symptoms, 9% reported depressive symptoms, and 27% reported both anxious and depressive symptoms. AAPI had lower odds of reporting both anxious/depressive symptoms compared to whites (OR = 0.59; 95% CI:0.43-0.81). Conclusion: Students reported elevated levels of psychological stress during the pandemic, yet our results may underestimate the actual odds due to stress brought on by COVID-19.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1473002
Database: ERIC
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  Value: <anid>AN0184444289;acl01apr.25;2025Apr15.05:17;v2.2.500</anid> <title id="AN0184444289-1">A rapid assessment of depressive and anxious symptoms among university students during the COVID-19 public health emergency: A repeated cross-sectional analysis </title> <p>Objectives: To identify potential associations between student characteristics and mental health symptoms during the early parts of the pandemic. Participants: 3,883 students at a large public university on the West Coast of the United States. Methods: We conducted a repeated cross-sectional survey to assess health-protective behaviors, mental health, social support, and stigma resistance. The survey was administered in April 2020 and again in November/December 2020. Odds of mental health symptoms were estimated using multinomial logistic regression. Results: 39% of respondents reported anxious symptoms, 9% reported depressive symptoms, and 27% reported both anxious and depressive symptoms. AAPI had lower odds of reporting both anxious/depressive symptoms compared to whites (OR = 0.59; 95% CI:0.43–0.81). Conclusion: Students reported elevated levels of psychological stress during the pandemic, yet our results may underestimate the actual odds due to stress brought on by COVID-19.</p> <p>Keywords: COVID-19; university students; mental health; depressive symptoms; anxiety symptoms</p> <hd id="AN0184444289-2">Background</hd> <p>College students are at risk for experiencing stress, anxiety, and depression.[<reflink idref="bib1" id="ref1">1</reflink>] The most common period for a person to experience major depression is from mid-adolescence to mid-40s, with many people experiencing their first episode of depression before twenty years of age and the average age of onset during the mid-twenties. Depression can be related to detrimental behaviors, and people who experience anxiety report a worsened quality of life.[<reflink idref="bib2" id="ref2">2</reflink>] COVID-19 has severely impacted peoples' mental health, and specific consideration of the feelings of anxiety and depression in college students is important to measure and use those results to inform and implement institutional changes.[<reflink idref="bib3" id="ref3">3</reflink>]</p> <p>By late March 2020,[<reflink idref="bib4" id="ref4">4</reflink>] State governments began mandating that residents shelter-in-place, and universities across the U.S. switched to remote/online delivery of classes and educational offerings. This significant disruption to traditional university life, while limiting the potential for spread, even among those students who had to remain in on-campus housing, influenced students' mental health in measurable ways beyond infection of the novel Coronavirus. Existing work on COVID-19 and mental health outcomes with a focus on adolescents, children, and college students has been limited,[[<reflink idref="bib5" id="ref5">5</reflink>], [<reflink idref="bib7" id="ref6">7</reflink>], [<reflink idref="bib9" id="ref7">9</reflink>], [<reflink idref="bib11" id="ref8">11</reflink>]] as has been little written about the impacts of those at minority-serving institutions, and even less about the effects of the mid-2020 switch to isolated living and remote schooling routines mandated by stay-at-home orders making a college population viable for study.</p> <p>California was one of the first states to issue a statewide state of emergency and an order to shelter in place, thus making it an ideal setting to assess the influence of COVID-19 on its residents' mental health in 2020. The first confirmed case of the novel Coronavirus in the state—reported by someone who had recently traveled to Wuhan, China—occurred in late January 2020 in Orange County, California, a populous county and part of the greater Los Angeles metropolitan area.[<reflink idref="bib12" id="ref9">12</reflink>]<sups>,</sups>[<reflink idref="bib13" id="ref10">13</reflink>] Given the prevalence of mental health conditions in young adults with the often close-quartering and diverse experience, a college population was ideal to study. College can be stressful, and the influence of a pandemic can increase stress and mental health-related symptoms in university students.[<reflink idref="bib14" id="ref11">14</reflink>] Previous studies examining anxiety symptoms using the GAD-7 screening tool[<reflink idref="bib15" id="ref12">15</reflink>] in Chinese American families during the COVID-19 pandemic found that their respondents experienced increased Sinophobia and anti-Asian racism. These results led to heightened mental health distress, illustrated by respondents' perceptions of how non-AAPI people viewed them and their own sense of belonging.[<reflink idref="bib16" id="ref13">16</reflink>]<sups>,</sups>[<reflink idref="bib17" id="ref14">17</reflink>] Similar challenges have been observed using the PHQ-9, where diverse racial and ethnic groups may not be adequately measured.[[<reflink idref="bib18" id="ref15">18</reflink>], [<reflink idref="bib20" id="ref16">20</reflink>], [<reflink idref="bib22" id="ref17">22</reflink>]]</p> <p>With known stressors on mental health during the COVID-19 pandemic, it is important to evaluate who might be disproportionately be afflicted. Our objective of this study was to identify potential associations between student characteristics and mental health symptoms during the early parts of the pandemic.</p> <hd id="AN0184444289-3">Materials and methods</hd> <p></p> <hd id="AN0184444289-4">Study population</hd> <p>The setting of this study was a large public University on the west coast of the United States. This Hispanic serving institution (HSI) and Asian American and Native American Pacific Islander-serving institution (AANAPSI) had a diverse student body of approximately 37,000 students, 80% of which are undergraduates.[<reflink idref="bib24" id="ref18">24</reflink>]<sups>,</sups>[<reflink idref="bib25" id="ref19">25</reflink>] Approximately 43% of undergraduate students live on campus, although 80% of PhD students also live on campus. [<reflink idref="bib26" id="ref20">26</reflink>]<sups>,</sups>[<reflink idref="bib27" id="ref21">27</reflink>]</p> <hd id="AN0184444289-5">Study design</hd> <p>A repeated cross-sectional survey was developed, disseminated through university email, and completed by students online. There were four survey waves,[<reflink idref="bib28" id="ref22">28</reflink>] focusing on COVID-19 students' knowledge, attitudes, and health behaviors. These waves occurred in February 2020 (Wave I), shortly after the first confirmed COVID-19 case in Orange County; late February/early March 2020 (Wave II), following the first community transmission case in the U.S. (identified in California) and Orange County's declaration of a state of emergency; mid-late April 2020 (Wave III), about one month after the university switched to remote instruction; late October/early November 2020 (Wave IV), preceding the winter holidays and following a second surge in cases in the state; and April-July 2022 (Wave V) following the various COVID-19 surges roughly two years into the pandemic[<reflink idref="bib28" id="ref23">28</reflink>] (Figure 1). Only Wave III and Wave IV of the survey asked questions about anxious and depressive symptoms (within the previous two weeks), which are the focus of this study. This study was certified as exempt from ethical oversight using a self-determination form provided by the university's Institutional Review Board.</p> <p>Graph: Figure 1. COVID-19 student survey timeline. Source: Boden-Albala B, Ding X, Ryan N, et al. Anti-Asian racism related stigma, racial discrimination, and protective factors against stigma: a repeated cross-sectional survey among university students during the COVID-19 pandemic. Frontiers in Public Health. 2023;11. Accessed September 26, 2023. https://<ulink href="http://www.frontiersin.org/articles/10.3389/fpubh.2023.958932">www.frontiersin.org/articles/10.3389/fpubh.2023.958932</ulink></p> <hd id="AN0184444289-6">Participant sampling</hd> <p>We recruited online from the entire university student population using a convenience sample. Any currently enrolled undergraduate or graduate student with an active email account was eligible, with the respondent self-reported their undergraduate/graduate student status. Students were emailed once to complete survey and then were reminded two weeks later.</p> <hd id="AN0184444289-7">Outcomes</hd> <p>The validated Patient Health Questionnaire-9 (PHQ-9) depression screening tool was used to assess depressive symptoms initially based on the DSM IV.[[<reflink idref="bib19" id="ref24">19</reflink>], [<reflink idref="bib21" id="ref25">21</reflink>]] Responses to each of the PHQ-9 questions were summed to create a total score, and standard cutoffs were used to classify depressive severity (0–9, no depression, 10–14, moderate depression, 15–19, moderate-severe depression, and >20, severe depression).[<reflink idref="bib19" id="ref26">19</reflink>]</p> <p>Anxiety symptoms were measured using the validated General Anxiety Disorder-7 (GAD-7) anxiety screening questionnaire.[<reflink idref="bib15" id="ref27">15</reflink>] Responses were summed across screening questions, and standard cutoffs were used to classify anxious symptoms: 0–9 no anxiety to mild anxiety, 10–14 moderate anxiety, and 15–21 severe anxiety.[<reflink idref="bib15" id="ref28">15</reflink>] We restricted our study sample to respondents who answered both the GAD-7 and PHQ-9 scales.</p> <hd id="AN0184444289-8">Covariates</hd> <p>Socio-demographic characteristics were collected, including age (ten-year age groups over the age of 19), gender (coded as male, female, transgender/nonbinary, chose not to answer), race, ethnicity (Asian American/Pacific Island, African American/Black., white, Hispanic/Latino, Some other race, Multiracial, American Indian/Alaska Native), income, occupation, student status (graduate or undergraduate), residence (urban or rural), housing location (on or off campus), and type of individual(s) with whom the student was living (partner, roommate, family, versus living alone). Stigma was measured using questions adapted from the HIV-stigma for people living with HIV/AIDS (HASI-P) tool,[[<reflink idref="bib29" id="ref29">29</reflink>], [<reflink idref="bib31" id="ref30">31</reflink>]] Responses were collected using a Likert-type scales (Appendix 1). Pretesting of the survey was completed before survey implementation.[<reflink idref="bib9" id="ref31">9</reflink>] Scores were summed to create a stigma score, with 0 corresponding to no stigma and 20 corresponding to the most stigma. These scores were analyzed as a continuous variable. Stigma resistance was measured using items from the validated Stigma Resistance Scale,[[<reflink idref="bib29" id="ref32">29</reflink>], [<reflink idref="bib31" id="ref33">31</reflink>]] and responses were collected using a Likert-type scale (i.e., strongly disagree, disagree, neutral, agree, strongly agree) and summed to create a stigma resistance score, with 0 corresponding to no stigma resistance and 20 the most resilient. Social support was measured using the eight-item Medical Outcomes Study Social Support Survey (mMOS-SS).[<reflink idref="bib32" id="ref34">32</reflink>] The total score was summed across the eight social support measures (0 being no social support and 32 being the most social support).[<reflink idref="bib9" id="ref35">9</reflink>] Cohabitation was dichotomized as living alone vs not living alone.</p> <hd id="AN0184444289-9">Statistical analysis</hd> <p>A descriptive analysis of the mental health outcomes was conducted, summarizing anxiety and depressive symptoms separately and in combination. We partitioned the combination of anxiety and depression symptoms into four category factorial schemas: no symptoms, anxiety symptoms only (GAD score ≥10), depressive symptoms only (PHQ-9 ≥ 10), and both anxiety and depressive symptoms (GAD and PHQ-9 both ≥10). Odds of anxiety and depression symptoms were analyzed using multinomial logistic regression of the four-category composite variable. Models were adjusted for undergraduate vs graduate student status, housing status, race-ethnicity, age, measures of stigma, social support, and stigma resistance. Odds ratios comparing levels of anxiety/depressive symptoms to neither anxiety nor depressive symptoms and corresponding 95% confidence intervals were calculated. Results were post-hoc stratified by survey wave to explore observed associations. All analyses were conducted using Stata version 18.[<reflink idref="bib33" id="ref36">33</reflink>]</p> <hd id="AN0184444289-10">Results</hd> <p>A total of 3,883 students responded to Wave III and Wave IV surveys sent to 31,000 students between April 23, 2020, and November 30, 2020.[<reflink idref="bib9" id="ref37">9</reflink>] Respondent characteristics are described in Table 1. The majority of student respondents were female (50%), lived off campus (80%), and were undergraduate (51%). Most students who reported their race/ethnicity were white (21%), with the next highest being AAPI (19%) and Hispanic/Latino (17%); a third were missing race/ethnicity data. Three-quarters of survey respondents indicated either depressive symptoms, anxious symptoms, or both depressive and anxious symptoms, with only a quarter of students (<reflink idref="bib970" id="ref38">970</reflink>) reporting neither depressive nor anxious symptoms. We found that 39% of respondents reported anxious symptoms, 9% reported depressive symptoms, and 27% reported both anxious and depressive symptoms across the two waves. We also saw an overall mean stigma score of 10 with a median of 13, indicating that at least half of the students are experiencing moderate to severe stigma according to the scale we used in this survey.</p> <p>Table 1. Frequencies and proportions of college students' demographic and mental health symptomology responses between April and November 2020 (<emph>N</emph> = 3,883). (We restricted our study sample to those who filled out the PHQ9 and GAD -7 questions of the survey).</p> <p> <ephtml> <table><thead><tr><td>Characteristic</td><td>N</td><td>%</td></tr></thead><tbody valign="top"><tr><td>Age</td><td /><td /></tr><tr><td> 15–17</td><td char=".">22</td><td char=".">0.57</td></tr><tr><td> 18–19</td><td char=".">757</td><td char=".">19.50</td></tr><tr><td> 20–29</td><td char=".">1,742</td><td char=".">44.86</td></tr><tr><td> 30–39</td><td char=".">199</td><td char=".">5.12</td></tr><tr><td> 40–49</td><td char=".">29</td><td char=".">0.75</td></tr><tr><td> 50–59</td><td char=".">11</td><td char=".">0.28</td></tr><tr><td> 80–89</td><td char=".">1</td><td char=".">0.03</td></tr><tr><td> Missing</td><td char=".">1,122</td><td char=".">28.90</td></tr><tr><td>Gender</td><td /><td /></tr><tr><td> Female</td><td char=".">1,956</td><td char=".">50.37</td></tr><tr><td> Male</td><td char=".">771</td><td char=".">19.86</td></tr><tr><td> Other/Trans/Non-Binary</td><td char=".">71</td><td char=".">1.83</td></tr><tr><td> Chose not to answer</td><td char=".">22</td><td char=".">0.57</td></tr><tr><td> Missing</td><td char=".">1,063</td><td char=".">27.38</td></tr><tr><td>Living on/off campus</td><td /><td /></tr><tr><td> Off campus</td><td char=".">3,096</td><td char=".">79.73</td></tr><tr><td> On campus</td><td char=".">787</td><td char=".">20.27</td></tr><tr><td>Student type</td><td /><td /></tr><tr><td> Graduate</td><td char=".">836</td><td char=".">21.53</td></tr><tr><td> Undergraduate</td><td char=".">1,976</td><td char=".">50.89</td></tr><tr><td> Missing</td><td char=".">1,071</td><td char=".">27.58</td></tr><tr><td>Race/Ethnicity</td><td /><td /></tr><tr><td> AAPI</td><td char=".">741</td><td char=".">19.08</td></tr><tr><td> Black</td><td char=".">54</td><td char=".">1.39</td></tr><tr><td> White</td><td char=".">819</td><td char=".">21.09</td></tr><tr><td> Hispanic/Latino</td><td char=".">676</td><td char=".">17.41</td></tr><tr><td> Some other race</td><td char=".">119</td><td char=".">3.06</td></tr><tr><td> Multiracial</td><td char=".">11</td><td char=".">0.28</td></tr><tr><td> AIAN</td><td char=".">198</td><td char=".">5.10</td></tr><tr><td> Missing</td><td char=".">1265</td><td char=".">32.58</td></tr><tr><td>Survey Wave</td><td char=".">860</td><td char=".">22.15</td></tr><tr><td> Wave III</td><td char=".">2,272</td><td char=".">58.51</td></tr><tr><td> Wave IV</td><td char=".">1,611</td><td char=".">41.49</td></tr><tr><td>Cohabitation</td><td /><td /></tr><tr><td> Lives alone</td><td char=".">294</td><td char=".">7.57</td></tr><tr><td> Lives with family/spouse</td><td char=".">1,812</td><td char=".">46.66</td></tr><tr><td> Lives with friends/roommates/neighbors</td><td char=".">688</td><td char=".">17.72</td></tr><tr><td> Missing</td><td char=".">1,089</td><td char=".">28.05</td></tr><tr><td>Anxiety symptoms as determined by the GAD-7 Screener</td><td /><td /></tr><tr><td> No anxiety</td><td char=".">1,342</td><td char=".">34.56</td></tr><tr><td> Moderate anxiety</td><td char=".">2,032</td><td char=".">52.33</td></tr><tr><td> Severe anxiety</td><td char=".">509</td><td char=".">13.11</td></tr><tr><td>Depressive symptoms as determined by the PHQ-9 screener</td><td /><td /></tr><tr><td> No Depression</td><td char=".">2,472</td><td char=".">63.66</td></tr><tr><td> Moderate depression</td><td char=".">643</td><td char=".">16.56</td></tr><tr><td> Moderate-severe depression</td><td char=".">440</td><td char=".">11.33</td></tr><tr><td> Severe depression</td><td char=".">328</td><td char=".">8.45</td></tr><tr><td>Factorial of symptoms as determined by the GAD-7 and PHQ-9 screeners</td><td /><td /></tr><tr><td> No symptoms</td><td char=".">970</td><td char=".">24.98</td></tr><tr><td> Anxiety symptoms only</td><td char=".">1,502</td><td char=".">38.68</td></tr><tr><td> Depression symptoms only</td><td char=".">372</td><td char=".">9.58</td></tr><tr><td> Anxiety and depression symptoms</td><td char=".">1,039</td><td char=".">26.76</td></tr></tbody></table> </ephtml> </p> <hd id="AN0184444289-11">Multinomial logistic regression results</hd> <p>Overall, anxious, depressive, and the combination of anxious and depressive symptoms were more common in Wave III compared to Wave IV (Table 2). In comparing anxious symptoms only to no symptoms, higher stigma total scores were associated with lower odds of anxiety (aOR = 0.96; 95% CI: 0.93–0.99).</p> <p>Table 2. Odds of anxiety and depressive symptomology among college students compared to no symptoms.*</p> <p> <ephtml> <table><thead><tr><td /><td>Anxiety only</td><td>Depression only</td><td>Anxiety and depression</td></tr></thead><tbody valign="top"><tr><td>Characteristic</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td></tr><tr><td><bold>Race</bold></td><td /><td /><td /></tr><tr><td>White</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>AAPI</td><td char=".">1.12, (0.78–1.60)</td><td char=".">0.99, (0.68–1.44)</td><td char=".">0.60, (0.44–0.83)</td></tr><tr><td>Black</td><td char=".">0.87, (0.32–2.38)</td><td char=".">1.13, (0.41–3.15)</td><td char=".">1.17, (0.51–2.70)</td></tr><tr><td>Hispanic/Latino</td><td char=".">1.18, (0.80–1.73)</td><td char=".">1.29, (0.86–1.93)</td><td char=".">0.98, (0.70–1.37)</td></tr><tr><td>Some other race</td><td char=".">1.48, (0.75–2.93)</td><td char=".">0.65, (0.28–1.51)</td><td char=".">0.99, (0.54–1.81)</td></tr><tr><td>Multiracial</td><td char=".">0.68, (0.03–13.55)</td><td char=".">3.08, (0.25–38.31)</td><td char=".">3.43, (0.34–34.59)</td></tr><tr><td>AIAN</td><td char=".">1.15, (0.65–2.03)</td><td char=".">0.88, (0.48–1.61)</td><td char=".">0.73, (0.45–1.19)</td></tr><tr><td>missing</td><td char=".">1.16, (0.54–2.50)</td><td char=".">1.57, (0.68–3.58)</td><td char=".">0.68, (0.31–1.47)</td></tr><tr><td><bold>Gender</bold></td><td /><td /><td /></tr><tr><td>Male</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>Female</td><td char=".">1.08, (0.81–1.46)</td><td char=".">0.75, (0.54–1.04)</td><td char=".">0.74, (0.56–0.96)</td></tr><tr><td>Other/Trans/Non-Binary</td><td char=".">1.11, (0.37–3.33)</td><td char=".">2.39, (0.88–6.54)</td><td char=".">2.42, (0.98–5.99)</td></tr><tr><td>Age (continuous)</td><td char=".">1.02, (0.99–1.06)</td><td char=".">0.99, (0.95–1.03)</td><td char=".">1.01, (0.98–1.04)</td></tr><tr><td>Stigma score total (continuous)</td><td char=".">0.96, (0.93–0.99)</td><td char=".">1.06, (1.02–1.10)</td><td char=".">1.06, (1.03–1.09)</td></tr><tr><td>Stigma resistance score total (continuous)</td><td char=".">0.96, (0.92–1.00)</td><td char=".">0.91, (0.87–0.96)</td><td char=".">0.85, (0.82–0.89)</td></tr><tr><td>Social support score total (continuous)</td><td char=".">0.98, (0.96–1.00)</td><td char=".">0.94, (0.92–0.96)</td><td char=".">0.95, (0.94–0.97)</td></tr><tr><td><bold>Living situation</bold></td><td /><td /><td /></tr><tr><td>Lives alone</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>lives with family/spouse</td><td char=".">1.19, (0.70–2.00)</td><td char=".">1.54, (0.89–2.67)</td><td char=".">1.30, (0.82–2.06)</td></tr><tr><td>lives with friends/roommates/neighbors</td><td char=".">1.22, (0.75–2.00)</td><td char=".">1.25, (0.76–2.05)</td><td char=".">1.16, (0.75–1.78)</td></tr><tr><td><bold>Undergraduate/Graduate Student Status</bold></td><td /><td /><td /></tr><tr><td>Graduate Student</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>Undergraduate Student</td><td char=".">0.92, (0.62–1.35)</td><td char=".">1.31, (0.85–2.01)</td><td char=".">1.36, (0.96–1.94)</td></tr><tr><td><bold>Living on/off campus</bold></td><td /><td /><td /></tr><tr><td>Off Campus</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>on campus</td><td char=".">0.92, (0.64–1.34)</td><td char=".">1.07, (0.72–1.60)</td><td char=".">0.75, (0.54–1.04)</td></tr><tr><td><bold>Survey Wave</bold></td><td /><td /><td /></tr><tr><td>Wave III</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>Wave IV</td><td char=".">0.02, (0.01–0.02)</td><td char=".">0.17, (0.12–0.24)</td><td char=".">0.09, (0.06–0.12)</td></tr><tr><td><bold>Constant</bold></td><td char=".">23.95, (6.77–84.77)</td><td char=".">8.25, (1.98–34.42)</td><td char=".">47.83, (14.74–155.19)</td></tr></tbody></table> </ephtml> </p> <p>1 *Adjusted by age, stigma resistance, social support, and stigma scores in quartiles, grad vs undergrad living alone versus living with family or living with friends/roommates, living on campus/not on campus, and Wave IV (odds ratios). No anxiety/Depression symptoms (reference).</p> <p>In comparing depressive symptoms only to no symptoms, for every unit greater stigma total score, the odds of depressive symptoms was 6% higher (aOR = 1.06; 95% CI: 1.02–1.10). Additionally, higher resilience scale scores were associated with lower odds of depressive symptoms (aOR = 0.91; 95% CI 0.87–0.96). We saw similar results with social support, where higher social support lowered the odds of depressive symptoms by 6% (aOR =0.94; 95% CI: 0.92–0.96).</p> <p>In comparing anxious and depressive symptoms to those with no symptoms, we saw that AAPI compared to whites had 40% lower odds of anxious and depressive symptoms compared to white students (aOR = 0.60, 95% CI 0.44–0.83). We also found that males compared to females, had 26% lower odds of depressive and anxious symptoms (aOR = 0.74, 95% CI: 0.56–0.96). When comparing anxious and depressive symptoms to those with no symptoms, we found similar results in the stigma, resilience, and social support total scores as we did for depressive symptoms vs neither anxious nor depressive symptoms: higher total stigma score was associated with higher odds of anxious and depressive symptoms (aOR= 1.06; 95% CI: 1.0–1.19), while greater resilience (aOR = 0.85; 95% CI 0.82–0.89) and social support (aOR = 0.95; 95% CI: 0.94–0.97) were associated with lower odds of depressive and anxious symptoms compared to those with no symptoms.</p> <p>Across both survey waves, social support had protective associations for anxiety and depressive symptomologies; students with the highest levels of social support reported the lowest odds of having mental health symptomologies. Stronger associations with social support were also observed between depression only and anxiety and depression compared to no depression and no anxiety. In stratified regressions, we saw AAPI as a protective association in Wave IV (aOR = 0.50; 95% CI 0.00–0.73) for anxiety and depression symptoms compared to neither anxiety nor depression symptoms (Supplemental Table 1). For Wave IV, we saw stigma as a constant driver for anxious and depressive symptoms OR = 1.07, (1.03–1.11). We also saw a consistent protective association across both waves by social support for anxious and depressive symptoms in Wave III (aOR = 0.93; 95% CI 0.89–0.97) and Wave IV (aOR = 0.95; 95% CI: 0.93–0.97).</p> <hd id="AN0184444289-12">Discussion</hd> <p>We found fewer depressive and anxious symptoms were reported among racial/ethnic minorities, particularly among AAPI, compared to whites among college students during the first year of the COVID-19 pandemic. This is consistent in the literature, in studies looking at mental health stigma. These studies found that ethnic minorities had negative views about mental illnesses and were more reluctant to disclose mental health issues.[<reflink idref="bib34" id="ref39">34</reflink>] The association that we observed may also be due to response and selection biases, as those AAPI students that responded may have been less likely to share their true mental health state.</p> <p>We must note the missingness in this survey and cannot assume it is missing at random. A third of the respondents did not answer the questions about race and ethnicity. Although some may be concerned about this level of missing data, the missingness seen in our survey was reflected similar missingness seen in other COVID-19 surveys conducted at the same time.[[<reflink idref="bib35" id="ref40">35</reflink>], [<reflink idref="bib37" id="ref41">37</reflink>]]. In general, AAPI and other minority respondents have refused to answer race/ethnicity questions due to fear of discrimination and a rise in AAPI hate crimes.[<reflink idref="bib34" id="ref42">34</reflink>] Those missing race/ethnicity within our study also had lower odds of anxiety symptoms and depression symptoms compared to non-Hispanic whites and may be inclusive of other AAPI respondents.[<reflink idref="bib16" id="ref43">16</reflink>]<sups>,</sups>[<reflink idref="bib17" id="ref44">17</reflink>]</p> <p>Given the differences in social norms among different racial/ethnic groups, questions arise about how sociodemographic factors affect the results of standardized anxiety and depression symptom screening tools. One study examined the effectiveness of one- and two- factor PHQ-9 screenings their reflectiveness when used with racial/ethnic minorities.[<reflink idref="bib23" id="ref45">23</reflink>] The researchers found that the two-factor screener was reflective of diverse racial/ethnic groups, including AIAN and also non-Hispanic/Latino respondents.[<reflink idref="bib19" id="ref46">19</reflink>]<sups>,</sups>[<reflink idref="bib23" id="ref47">23</reflink>] This study, with a large sample size of over 22,500 students across 51 universities, also found that the two-questionnaire PHQ-9 model was a better fit for diverse racial/ethnic groups and helped capture the multifaceted nature of depressive symptoms[<reflink idref="bib18" id="ref48">18</reflink>]<sups>,</sups>[<reflink idref="bib23" id="ref49">23</reflink>] When examining anxiety symptoms, a study using the GAD-7 questionnaire found a high level of internal consistency within the sample. However, the small number of minority respondents made validating challenging.[<reflink idref="bib22" id="ref50">22</reflink>]<sups>,</sups>[<reflink idref="bib38" id="ref51">38</reflink>] These results imply that the GAD-7 may be an ideal screening tool for respondents who identified as white but less so among minorities, due to insufficient validation data among these populations. Our results indicate the need for more studies examining how these screeners are used among minority respondents and diverse populations.</p> <p>Groups with a history of marginalization, including those based on race/ethnicity and gender, identified as experiencing more depressive and anxious symptoms during the COVID-19 pandemic, also using the PHQ-9 and GAD-7. These results imply that the COVID-19 pandemic may have created an exogenic mental health shock and that respondents with increased scores from their first score increased due to the pandemic.[<reflink idref="bib39" id="ref52">39</reflink>] Existing marginalization exacerbates the problem when students find it increasingly difficult to access on-campus resources, such as counseling centers, during a pandemic because university buildings and offices are closed.</p> <p>The stigma resistance and social support scale scores may also explain the lower odds of anxiety and depression symptoms in our surveys.[<reflink idref="bib30" id="ref53">30</reflink>] We found a protective effect with higher stigma resistance and higher social support scores: individuals with strong social support had the lowest odds of anxiety and depression symptoms. Specifically, higher social support scores were associated with fewer anxiety and depressive symptoms. Our findings are consistent with the literature, which indicates that increased stigma resistance and strong social support can help mitigate depressive and anxious symptoms.[<reflink idref="bib40" id="ref54">40</reflink>]<sups>,</sups>[<reflink idref="bib41" id="ref55">41</reflink>] Several studies found that more than half of their respondents reported seeking social support from family, using mobile phone applications and other digital platforms.[<reflink idref="bib29" id="ref56">29</reflink>]<sups>,</sups>[<reflink idref="bib41" id="ref57">41</reflink>] Another study found that respondents who received adequate support for mental health concerns helped mitigate stigma and fear. Additionally, the study encouraged more outreach and education for mental health issues at churches, primary care facilities, and community centers for those who may be uncomfortable seeking mental health assistance.[<reflink idref="bib42" id="ref58">42</reflink>]</p> <p>Our analysis found lower reported symptoms at Wave IV compared to Wave III and lower odds of combined depressive and anxiety symptoms between Wave III and Wave IV. These results may be due to the timing of the surveys. We administered the Wave III survey in 2020 when the campus first moved to remote learning and no vaccine was yet developed. Wave IV was initiated six months later, after "Operation Warp Speed," which included vaccine development, rapid testing, and other pandemic disease control activities.[<reflink idref="bib18" id="ref59">18</reflink>]<sups>,</sups>[<reflink idref="bib43" id="ref60">43</reflink>] Other studies examined the overall decline in mental health symptoms over time during the pandemic after March 2020 as testing improved and vaccines were developed reducing, people's COVID-19 fears. [<reflink idref="bib38" id="ref61">38</reflink>]<sups>,</sups>[<reflink idref="bib39" id="ref62">39</reflink>] However, this may underestimate the true prevalence of mental health symptoms due to the convenience sampling used to recruit respondents for this study and we cannot rule out the fact that we could had different participants responding during each wave.</p> <p>Changes in the university experience due to COVID-19 may be responsible for the observations we made regarding mental health symptoms. The existing support system for students fundamentally changed as on-campus operations switched to remote. Students who were used to getting meals at the dormitories now had to find alternatives. Some students ended up working once family members were laid off, and some students effectively lost their jobs.[<reflink idref="bib44" id="ref63">44</reflink>]<sups>,</sups>[<reflink idref="bib45" id="ref64">45</reflink>] Students were initially more engaged with remote learning but experienced increased frustration with online instruction and were less engaged in their learning.[<reflink idref="bib46" id="ref65">46</reflink>] Other studies found that a sense of community and access to resources were the most helpful mitigation factors during the pandemic.[<reflink idref="bib47" id="ref66">47</reflink>] Removing students from their existing community and access to in-person resources such as a student counseling center led to increased disruptions of daily life during the pandemic. Consequently, those students may have to seek off-campus mental health counseling or telehealth services.[<reflink idref="bib27" id="ref67">27</reflink>]<sups>,</sups>[<reflink idref="bib48" id="ref68">48</reflink>]</p> <p>Different needs of on-campus versus off-campus students should still be considered in future university pandemic policies, although the results in this sample were not statistically significant. Students who live off-campus may be less likely to access university resources, while those on campus may be less likely to access specialty mental health care found off campus or rely solely on telehealth.[<reflink idref="bib49" id="ref69">49</reflink>]<sups>,</sups>[<reflink idref="bib50" id="ref70">50</reflink>] Understanding student mental health and counseling needs across diverse living situations could help improve overall student morale and mental health.</p> <hd id="AN0184444289-13">Limitations</hd> <p>Many of our research limitations related to the challenges of conducting a rapid quantitative study during a pandemic.[<reflink idref="bib51" id="ref71">51</reflink>]<sups>,</sups>[<reflink idref="bib52" id="ref72">52</reflink>] Existing stigma scales were adapted and used which have not been validated in non-HIV affected populations. PHQ-9 and GAD-7 questions were only asked during Waves III and IV, and we do not know students' baseline mental health symptoms before the pandemic or before Wave III was administered, nor do we know about other existing medical conditions. We aimed to create a survey that could be administered quickly and measure different topics,[<reflink idref="bib9" id="ref73">9</reflink>] so detailed health histories were not collected. Not all participants responded to the survey's race and ethnicity questions. The sociodemographic questions were asked at the end of the survey, and approximately 33% of respondents did not fill out the race/ethnicity portion across both survey waves. This may be due to survey fatigue, hesitancy to report race by respondents, or recent upticks in AAPI violence and other minority stress.[<reflink idref="bib18" id="ref74">18</reflink>] As this was a repeated cross-sectional study, we different respondents may have been surveyed at each wave.[<reflink idref="bib9" id="ref75">9</reflink>]</p> <p>Due to the cross-sectional nature of this study, we cannot determine causality or temporality between anxious and depressive symptoms and stigma, resilience, and social support. We cannot rule out the possibility of reverse causality, wherein individuals with mental health symptoms later had increased resilience, social support, and stigma, or vice versa. We are not able to determine if these exposures occurred before or after the onset of mental health symptoms, and we did not ask about previous history of mental illness in our surveys. We must acknowledge potential threats to external validity with our results. Students likely had similar thoughts and fears as students on similar-sized university campuses, making our results potentially generalizable to similar institutions. However, these descriptive results are essential for this academic institution and similarly diverse universities in terms of allocating appropriate resources such as mental health counseling and support, or informing future planning for mental health resources during emergencies or future pandemics.</p> <hd id="AN0184444289-14">Conclusion</hd> <p>Students reported high levels of psychological distress during the pandemic. However, these results may underestimate the actual prevalence of anxious and depressive symptoms during this period. The student experience, particularly among marginalized groups may be missing from conversations about the COVID-19 pandemic and mental health. Further studies need to be conducted with larger samples and the same respondents over time.</p> <p>The missingness in our survey is meaningful because we do not know if there is a lack of mental health resources in languages other than English. The absence of race/ethnicity information and the language spoken at home makes it challenging for universities to effectively allocate funding to provide targeted resources for the groups that need it most. This study also notes an there may be an unmet need for mental health symptom support among university students, especially during times of crisis. Examples of these services may include increased training for student-facing employees and programming to recognize these symptoms and help refer them to appropriate services.[<reflink idref="bib26" id="ref76">26</reflink>] Even if these services are available, students may not access them due to the stigma related to mental health symptoms.</p> <p>Early recognition of these symptoms during a public health crisis could help students with mental health symptoms to therapy or psychiatric care. In the future, students must be included in discussions with university administrators about preventing further mental health symptoms as the COVID-19 pandemic transitions to an endemic state and to prepare for future public health emergencies.</p> <hd id="AN0184444289-15">Acknowledgments</hd> <p>Dr. Goodman was responsible for coding the data, performing the analysis, drafting, and writing the manuscript; Dr. Wing supervised the analysis and interpretation and assisted in writing the manuscript. Drs. Boden-Albala, Runnerstrom, and Ryan provided technical expertise to help edit and for this manuscript. Ms. Drum, Ms. Gibbs, and Ms. Guitterez helped with survey development and reading manuscript drafts. The named authors have no conflict of interest, financial or otherwise. Each of the authors confirms that this manuscript has not been previously published and is not currently under consideration by any other journal. Additionally, all authors have approved this paper's contents and agreed to the <emph>Journal of American College Health</emph> submission policies.</p> <hd id="AN0184444289-16">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States. This study was certified as exempt from ethical oversight using a self-determination form provided by the university's Institutional Review Board.</p> <hd id="AN0184444289-17">Appendix 1. Stigma questions from the wave III and wave IV surveys.</hd> <p>Stigma questions</p> <p>In the past one month, how often did the following events happen because of your identity or perceived identity as part of a group some people may believe are high risk of COVID- 19 transmission during the outbreak in the US.</p> <p></p> <p> <ephtml> <table><thead><tr><td>Most of the time</td><td>Several times</td><td>Once or twice</td><td>Never</td></tr></thead><tbody valign="top"><tr><td>• Someone has mocked me, stopped being my friend, called me by a bad name, or avoided me.</td></tr><tr><td>• I felt ashamed, worthless, or like I am no longer a person.</td></tr></tbody></table> </ephtml> </p> <p>In the next month, how often do you perceive the following events will happen because of your identity or perceived identity as part of a group some people may believe are high risk of COVID-19 transmission during the outbreak in the US.</p> <p></p> <p> <ephtml> <table><thead><tr><td>Most of the time</td><td>Several times</td><td>Once or twice</td><td>Never</td></tr></thead><tbody valign="top"><tr><td>• Someone will mock me, stop being my friend, call me by a bad name, or avoid me.</td></tr></tbody></table> </ephtml> </p> <p>Please explain why you have been or could be stigmatized during the COVID-19 pandemic.</p> <p></p> <p>Coping and stigma resistance</p> <p>Within the last two weeks, have you personally engaged in any of the following activities addressing COVID-related stigma? (Select all that apply)</p> <p></p> <p> <ephtml> <table><thead><tr><td>Yes</td><td>No</td><td>I don't know or don't remember</td></tr></thead><tbody valign="top"><tr><td>• Providing social support for people who have returned from affected areas or are worried about friends or family in the affected areas</td></tr><tr><td>• Sharing what you learn about preventing disease with your family and friends</td></tr><tr><td>• Being cautious about the images that you see and share in media and online. Making sure they do not reinforce stereotypes</td></tr><tr><td>• Speaking out against negative behaviors, including negative statements on social media about groups of people, or exclusion of people who pose no risk from regular activities</td></tr></tbody></table> </ephtml> </p> <p>If you needed it, how often is someone available...</p> <p></p> <p> <ephtml> <table><thead><tr><td>None of the time</td><td>A little of the time</td><td>Some of the time</td><td>Most of the time</td><td>All of the time</td></tr></thead><tbody valign="top"><tr><td>• who understands your problems?</td></tr><tr><td>• to have a good time with?</td></tr><tr><td>• to help with daily chores if you were sick?</td></tr><tr><td>• to help you if you were confined to bed?</td></tr><tr><td>• to prepare your meals if you are unable to do it yourself?</td></tr><tr><td>• to turn to for suggestions about how to deal with a personal problem?</td></tr><tr><td>• to take you to the doctor if you need it?</td></tr><tr><td>• to love and make you feel wanted?</td></tr></tbody></table> </ephtml> </p> <p>The next questions concern your ability to execute a course of action required to deal with prospective situations.</p> <p></p> <p> <ephtml> <table><thead><tr><td>Not at all true</td><td>Hardly true</td><td>Moderately true</td><td>Exactly true</td></tr></thead><tbody valign="top"><tr><td>• I am confident that I could deal efficiently with unexpected events.</td></tr><tr><td>• I can remain calm when facing difficulties because I can rely on my coping abilities.</td></tr><tr><td>• It is easy for me to stick to my aims and accomplish my goals.</td></tr><tr><td>• No matter what comes my way, I'm usually able to handle it.</td></tr><tr><td>• If someone opposes me, I can find ways to get what I want.</td></tr><tr><td>• Thanks to my resourcefulness, I know how to handle unforeseen situations.</td></tr></tbody></table> </ephtml> </p> <p>Within the last two weeks, how frequently have you engaged in the following activities?</p> <p></p> <p> <ephtml> <table><thead><tr><td>Always</td><td>Sometimes</td><td>Never</td></tr></thead><tbody valign="top"><tr><td>• Staying virtually connected with others (using phone calls, text messages, video chat and social media) and discuss your experience and emotions</td></tr><tr><td>• Relying on pets for emotional support</td></tr><tr><td>• Using mindfulness and relaxation exercises (deep breathing, positive imagery, muscle relaxation), including through smartphone applications</td></tr><tr><td>• Using telehealth options (phone-based or online) for therapy</td></tr><tr><td>• Volunteering to help others who are most vulnerable</td></tr><tr><td>• Balancing time between reading news/social media with activities not related to quarantine or isolation (i.e., reading, listening to music)</td></tr><tr><td>• Using psychological strategies to manage stress and stay positive (trying not to catastrophize; focusing on what you can do and accepting things you cannot change)</td></tr><tr><td>• Focusing on altruistic reasons for social distancing, quarantine, isolation-to reduce transmission of COVID-19 and protect the most vulnerable</td></tr><tr><td>• Limiting your news consumption to sources considered reliable (meaning with accurate and timely public health information regarding COVID-19)</td></tr><tr><td>• Maintaining a healthy lifestyle: getting enough sleep, eating well, exercising, avoiding excessive alcohol or drugs</td></tr><tr><td>• Creating and following a daily routine (including work, exercise, learning, and play)</td></tr></tbody></table> </ephtml> </p> <p>People who are stigmatized, their lives are worsened by stigma, thus leading to public prejudice, loss of self-worth, and negative implications for health and well-being. Asians and Asian Americans may be exposed to stigma during the COVID-19 pandemic. These next questions ask about stigma resistance.</p> <p>Please read the following statements and indicate how much you disagree or agree.</p> <p></p> <p> <ephtml> <table><thead><tr><td>Strongly disagree</td><td>Disagree</td><td>Neither Agree or disagree</td><td>Agree</td><td>Strongly agree</td></tr></thead><tbody valign="top"><tr><td>• I help others see they should not be ashamed about being Asian or Asian American.</td></tr><tr><td>• Resisting stigma means speaking up when others say negative things about Asians or Asian Americans regarding COVID-19.</td></tr><tr><td>• To resist stigma, I think positive things about myself.</td></tr><tr><td>• I help others resist stigma by showing I believe in them.</td></tr><tr><td>• When I encounter stigma, I can think of why these attitudes are wrong.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0184444289-18">Appendix 2. Table 1 odds of anxiety and depressive symptomology among college students compar...</hd> <p></p> <p> <ephtml> <table><thead><tr><td>Wave III stratified <italic>n</italic> = 1,539</td><td>Wave IV stratified <italic>n</italic> = 1200</td></tr><tr><td>Anxiety symptoms only</td><td>Depression only</td><td>Anxiety and depression</td><td>Anxiety only</td><td>Depression only</td><td>Anxiety and depression</td></tr></thead><tbody valign="top"><tr><td>Characteristic</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td><td>Adjusted OR, (95% CI)</td></tr><tr><td><bold>Race</bold></td></tr><tr><td>White</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>AAPI</td><td char=".">1.62, (0.74–3.54)</td><td char=".">0.97, (0.40–2.39)</td><td char=".">0.99, (0.45–2.17)</td><td char=".">1.09, (0.60–1.99)</td><td char=".">1.10, (0.00–1.73)</td><td char=".">0.50, (0.00–0.73)</td></tr><tr><td>Black</td><td char=".">1.37, (0.17–11.24)</td><td char=".">2.51, (0.26–24.50)</td><td char=".">1.38, (0.16–11.75)</td><td>--<xref ref-type="table-fn" rid="tfn2">1</xref></td><td>--</td><td>--</td></tr><tr><td>Hispanic/Latino</td><td char=".">1.06, (0.52–2.16)</td><td char=".">1.01, (0.45–2.26)</td><td char=".">0.85, (0.41–1.73)</td><td char=".">1.07, (0.00–2.08)</td><td char=".">1.42, (0.00–2.33)</td><td char=".">1.04, (0.00–1.55)</td></tr><tr><td>Some other race</td><td char=".">1.11, (0.30–4.09)</td><td char=".">0.49, (0.10–2.49)</td><td char=".">0.73, (0.19–2.76)</td><td char=".">1.73, (0.00–4.86)</td><td char=".">0.63, (0.00–1.81)</td><td char=".">1.04, (0.00–2.08)</td></tr><tr><td>Multiracial</td><td>--</td><td>--</td><td>--</td><td>--</td><td>--</td><td char=".">5.32, (0.46–61.98)</td></tr><tr><td>AIAN</td><td char=".">1.84, (0.50–6.74)</td><td char=".">1.08, (0.25–4.75)</td><td char=".">1.11, (0.30–4.10)</td><td char=".">0.79, (0.29–2.18)</td><td char=".">0.90, (0.44–1.81)</td><td char=".">0.70, (0.40–1.22)</td></tr><tr><td>missing</td><td char=".">1.31, (0.52–3.30)</td><td char=".">1.54, (0.56–4.24)</td><td char=".">0.82, (0.32–2.09)</td><td char=".">3.50, (0.41–30.12)</td><td char=".">1.83, (0.31–10.83)</td><td char=".">0.49, (0.07–3.64)</td></tr><tr><td><bold>Gender</bold></td></tr><tr><td>Male</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>Female</td><td char=".">1.49, (0.79–2.81)</td><td char=".">0.83, (0.40–1.73)</td><td char=".">1.02, (0.53–1.94)</td><td char=".">0.74, (0.43–1.27)</td><td char=".">0.80, (0.55–1.18)</td><td char=".">0.68, (0.49–0.94)</td></tr><tr><td>Other/Trans/Non-Binary</td><td>--<xref ref-type="table-fn" rid="tfn3">2</xref></td><td>--</td><td>--</td><td char=".">0.66, (0.08–5.63)</td><td char=".">2.60, (0.88–7.64)</td><td char=".">1.84, (0.70–4.88)</td></tr><tr><td><bold>Age (continuous)</bold></td><td char=".">1.01, (0.95–1.08)</td><td char=".">0.98, (0.91–1.06)</td><td char=".">1.00, (0.94–1.07)</td><td char=".">1.05, (0.99–1.10)</td><td char=".">0.98, (0.93–1.03)</td><td char=".">1.00, (0.97–1.04)</td></tr><tr><td><bold>Stigma score total (continuous)</bold></td><td char=".">0.91, (0.84–0.98)</td><td char=".">1.06, (0.97–1.16)</td><td char=".">1.02, (0.94–1.10)</td><td char=".">1.04, (0.99–1.10)</td><td char=".">1.02, (0.98–1.06)</td><td char=".">1.07, (1.03–1.11)</td></tr><tr><td><bold>Stigma resistance score total (continuous)</bold></td><td char=".">1.07, (0.98–1.18)</td><td char=".">1.02, (0.92–1.13)</td><td char=".">0.93, (0.85–1.02)</td><td char=".">0.88, (0.82–0.96)</td><td char=".">0.89, (0.84–0.94)</td><td char=".">0.85, (0.81–0.90)</td></tr><tr><td><bold>Social support score total (continuous)</bold></td><td char=".">0.95, (0.91–1.00)</td><td char=".">0.91, (0.87–0.95)</td><td char=".">0.93, (0.89–0.97)</td><td char=".">1.01, (0.98–1.05)</td><td char=".">0.95, (0.92–0.97)</td><td char=".">0.95, (0.93–0.97)</td></tr><tr><td><bold>Living situation</bold></td></tr><tr><td>Lives alone</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>lives with family/spouse</td><td char=".">0.38, (0.08–1.75)</td><td char=".">0.59, (0.11–3.02)</td><td char=".">0.41, (0.09–1.93)</td><td char=".">1.93, (0.76–4.89)</td><td char=".">1.57, (0.81–3.06)</td><td char=".">1.43, (0.83–2.46)</td></tr><tr><td>lives with friends/roommates/neighbors</td><td char=".">0.47, (0.10–2.18)</td><td char=".">0.44, (0.09–2.26)</td><td char=".">0.43, (0.09–2.01)</td><td char=".">1.46, (0.61–3.49)</td><td char=".">1.42, (0.79–2.56)</td><td char=".">1.19, (0.73–1.96)</td></tr><tr><td><bold>Undergraduate/Graduate Student Status</bold></td></tr><tr><td>Graduate Student</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>Undergraduate Student</td><td char=".">1.16, (0.54–2.46)</td><td char=".">1.83, (0.76–4.41)</td><td char=".">2.09, (0.97–4.53)</td><td char=".">1.54, (0.79–3.03)</td><td char=".">1.30, (0.76–2.22)</td><td char=".">1.05, (0.69–1.59)</td></tr><tr><td><bold>Living on/off campus</bold></td></tr><tr><td>Off Campus</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td><td>Reference</td></tr><tr><td>on campus</td><td char=".">0.00, (0.00–0.00)</td><td char=".">1.34, (0.57–3.13)</td><td char=".">0.74, (0.35–1.58)</td><td char=".">0.00, (0.00–0.00)</td><td char=".">0.95, (0.58–1.55)</td><td char=".">0.74, (0.50–1.09)</td></tr><tr><td><bold>Constant</bold></td><td char=".">75.84, (5.31–1,082.41)</td><td char=".">10.82, (0.52–225.04)</td><td char=".">114.57, (7.65–1,716.18)</td><td char=".">0.04, (0.00–0.36)</td><td char=".">3.12, (0.55–17.58)</td><td char=".">5.02, (1.30–19.41)</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 <sups>1</sups>These values were not estimable due to small cell sizes.</item> <item>3 <sups>2</sups>These values were not estimable due to small cell sizes.</item> </ulist> <ref id="AN0184444289-19"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2024.2400114.</bibtext> </blist> </ref> <ref id="AN0184444289-20"> <title> References </title> <blist> <bibtext> Tosevski DL, Milovancevic MP, Gajic SD. 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Goodman; Bernadette Boden-Albala; Emily Drum; Nessa Ryan; Brooke Gibbs; Desiree Gutierrez; Miryha Gould Runnerstrom and Jeffrey J. 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Header DbId: eric
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An: EJ1473002
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PubType: Academic Journal
PubTypeId: academicJournal
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: A Rapid Assessment of Depressive and Anxious Symptoms among University Students during the COVID-19 Public Health Emergency: A Repeated Cross-Sectional Analysis
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Sara+H%2E+Goodman%22">Sara H. Goodman</searchLink><br /><searchLink fieldCode="AR" term="%22Bernadette+Boden-Albala%22">Bernadette Boden-Albala</searchLink><br /><searchLink fieldCode="AR" term="%22Emily+Drum%22">Emily Drum</searchLink><br /><searchLink fieldCode="AR" term="%22Nessa+Ryan%22">Nessa Ryan</searchLink><br /><searchLink fieldCode="AR" term="%22Brooke+Gibbs%22">Brooke Gibbs</searchLink><br /><searchLink fieldCode="AR" term="%22Desiree+Gutierrez%22">Desiree Gutierrez</searchLink><br /><searchLink fieldCode="AR" term="%22Miryha+Gould+Runnerstrom%22">Miryha Gould Runnerstrom</searchLink><br /><searchLink fieldCode="AR" term="%22Jeffrey+J%2E+Wing%22">Jeffrey J. Wing</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(4):1711-1720.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 10
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research<br />Tests/Questionnaires
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Pandemics%22">Pandemics</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Support+Groups%22">Social Support Groups</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Resistance+%28Psychology%29%22">Resistance (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Minority+Serving+Institutions%22">Minority Serving Institutions</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Diversity%22">Student Diversity</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Differences%22">Racial Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Ethnicity%22">Ethnicity</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2024.2400114
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: To identify potential associations between student characteristics and mental health symptoms during the early parts of the pandemic. Participants: 3,883 students at a large public university on the West Coast of the United States. Methods: We conducted a repeated cross-sectional survey to assess health-protective behaviors, mental health, social support, and stigma resistance. The survey was administered in April 2020 and again in November/December 2020. Odds of mental health symptoms were estimated using multinomial logistic regression. Results: 39% of respondents reported anxious symptoms, 9% reported depressive symptoms, and 27% reported both anxious and depressive symptoms. AAPI had lower odds of reporting both anxious/depressive symptoms compared to whites (OR = 0.59; 95% CI:0.43-0.81). Conclusion: Students reported elevated levels of psychological stress during the pandemic, yet our results may underestimate the actual odds due to stress brought on by COVID-19.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1473002
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1473002
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2024.2400114
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 1711
    Subjects:
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Anxiety
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: Pandemics
        Type: general
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Social Support Groups
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Resistance (Psychology)
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: Minority Serving Institutions
        Type: general
      – SubjectFull: Student Diversity
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: Ethnicity
        Type: general
    Titles:
      – TitleFull: A Rapid Assessment of Depressive and Anxious Symptoms among University Students during the COVID-19 Public Health Emergency: A Repeated Cross-Sectional Analysis
        Type: main
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      – PersonEntity:
          Name:
            NameFull: Sara H. Goodman
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            NameFull: Bernadette Boden-Albala
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            NameFull: Nessa Ryan
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            NameFull: Brooke Gibbs
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            NameFull: Desiree Gutierrez
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            NameFull: Miryha Gould Runnerstrom
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            NameFull: Jeffrey J. Wing
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
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              Value: 1940-3208
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              Value: 73
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            – TitleFull: Journal of American College Health
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