Abstract
The roles of trait anxiety, psychological flexibility and coping strategies on the mental health impacts of COVID-19 on college students in India
INTRODUCTION
The lives of many students had a tremendous impact during the COVID-19 pandemic. Moreover, pandemic woes got extended due to the second wave when everyone was expecting an end to a year long-suffering in India. Schools, universities and institutes were shut down, resulting in the online culture again. Further, uncertainty over the exam dates apart from the competition itself loomed the distress and added misery for those transitioning to college. Recent studies suggest that COVID-19 increases psychological stress. More specifically, quarantine is associated with emotional stress, depression, irritation, adverse changes in sleep patterns and emotional tiredness. Despite the devastating psychosocial and cognitive impact of COVID-19 on individuals suffering from COVID-19 or not, some individuals did not get affected as much as others. In this study, we evaluate the individual coping strategies and psychological flexibility, and their association with trait anxiety to explain these individual differences in psychological health (generalized anxiety, depression, and stress) and cognitive health using cognitive tasks in the context of the COVID-19 pandemic in India. Such analysis would not only help to shed more light on the underlying nature of the effects of pandemic stressors but would also enable healthcare professionals to design particular interventions at the individual level.
METHOD
Total 254 college students (75 women, 176 men, 1 trans woman, 2 did not specify; mean age=20.57, median age=20) were recruited for this study and were provided monetary incentives. The data collection lasted for 3.5 weeks, starting from 22 September 2021, while the second wave was declining.
The study consisted of a general demographics survey, COVID-19 specific impact variables (such as living conditions, unhealthy behaviours, impact on academic life), and delirium questions. Patient Health Questionnaire (PHQ-9) for measuring the severity of depressive symptoms, Generalized Anxiety Disorder Questionnaire (GAD-7) to assess anxiety disorder, Perceived Stress Scale (PSS-10) for evaluating the degree to which the student perceives life as unpredictable and State-Trait Anxiety Inventory (STAI-10) for measuring potentiality as well as the actuality of anxiety. To assess the coping style and psychological flexibility, Brief COPE-28 and Multidimensional Psychological Flexibility Inventory (MPFI-24) were employed, respectively. Further, Stroop Task and Sustained Attention to Response Task (SART) were used as objective measures to assess the individual's ability to inhibit cognitive interference and attention, respectively.
RESULTS
Among 254 college students who participated in this study, 73.6% reported having a close one infected with the virus, among which 19.7% passed away, showing the significant prevalence of COVID-19 in India during the time of the study. Further, 26.7% of the participants reported being self infected by the virus, among which 2.9% were put on a ventilator. Among these covid infected participants, 17.6% reported experiencing strange things that they could not explain, 16.2% felt people were talking about them behind their back, and 2.9% heard or saw things that others could not, which corroborates recent findings on delirium in COVID-19 patients. On a scale of 1-5, among the sample, the mean academic stress was found to be 4.07 (median=4) and stress due to social isolation 3.93 (median=4). Three major analyses: correlational, regression and mediation, were performed to evaluate the relation of COVID-19 impact variables and psychological health.
We observed a strong negative correlation (p<0.01) between the measures such as perception of mental space, proper sleep, managing academics, social isolation during the pandemic with at least three out of the four mental health variables: PHQ, GAD, PSS and STAI-S (state) suggesting that poorer the student's ability to manage his/her/their life effectively the worse is the overall anxiety levels and depressive symptoms. For further analysis, these measures were collated into a single index called COVID-19 Impact Index, as they describe the overall impact on the lives of college students during the pandemic.
The COVID-19 Impact Index was significantly positively correlated (p<0.01) with the measures such as PHQ [ρ=0.54], GAD [ρ=0.51] and PSS [ρ=0.48], suggesting a high level of distress and depressive symptoms among students most impacted by COVID-19.
For investigating the relationship between dependent variables (PSS, PHQ, GAD and STAI-S) with the variables such as COVID-19 Impact Index, coping strategies, psychological flexibility and STAI-T, a multilinear regression model was trained for each dependent variable individually. The individual models trained for the outcome as PSS, PHQ, GAD, and STAI-S accounted for a significant portion of the variance by predicting 62.8%, 60.3%, 58.8%, and 47.5% of the variance, respectively. Significant contributors in the variance of all the models were found to be trait anxiety (STAI-T) and COVID-19 Impact Index, which suggests that the student's predisposition to experience negative emotions such as worries, fears, and anxiety is among other factors a relatively significant predictor of the negative experience during the pandemic time. Avoidant coping strategy and psychological inflexibility were also significant predictors in most of the models, suggesting that the students who chose to avoid rather than deal with the stressors posed by the COVID-19 situation were more likely to develop depressive symptoms, stress and anxiety.
The central role of STAI-T is further confirmed with the mediational analysis of the direct effect of the COVID-19 Impact Index on psychological health variables (PSS, PHQ, GAD and STAI-S). STAI-T is found to be most significantly positively mediating the direct effect in all the models compared to other parallel mediators: psychological flexibility and coping strategies, suggesting a higher increase in overall worsening of psychological health due to COVID-19 impact when a student has a predisposition of anxiety as compared to other students.
DISCUSSION AND CONCLUSION
This study showed the severe impact of COVID-19 amongst the students after the second wave ended, corroborating recent worldwide studies. Further, it helped to identify specific factors that result in individual differences while dealing with the pandemic's stressors due to its uncertain nature.
Predisposition to anxiety (STAI-T), among other factors, was crucial when predicting the propensity to depression, stress and anxiety; thus, such individuals could be identified early on. Health professionals can further employ approaches that promote psychological flexibility, such as Acceptance Commitment Therapy and educate about different coping styles promoting active coping.