Currently, the COVID-19 pandemic is a public health emergency of international concern, and governments have had to improvise strategies to keep afloat essential sectors such as education. Because of the conditions caused by the pandemic, UNESCO supports countries in their efforts to reduce the immediate impact of school closures and facilitate the continuity of education for all through distance learning, such as online learning programs 14. In the USA, student preference for fully online courses has increased in recent years 18, but the student population in Mexico does not seem comfortable with the idea of distance education, and most students still prefer face-to-face academic programs. Additionally, as many students may be struggling psychologically because of the overall situation, it could be challenging for most students to maintain the same enthusiasm for online classes as for the face-to-face classroom environment.
Despite being a handy tool, it is essential to remember that the online modality of education also has some setbacks. For starters, not all students or university faculty are technologically skillful to access or manage the conference tools or online classrooms platforms available, complicating the process for both the lecturer and the students. 19 Additionally, for this modality to work, they all must have access to a computer or a laptop and a fast or stable internet connection as most classes are live. Orellana et al. defined one of the most critical challenges of virtual education for both students and teachers as the lack of interest and enthusiasm. The authors mention that students must be self-motivated, as being outside a classroom could alter their attention span and be susceptible to distractions outside the class. Also, both faculty members and students must acquire quickly the technological skills needed to use the classes materials successfully 20.
Some possible content-related issues include the role of instructors in content development and integration of multimedia. Instructors must modify their teaching style, time management, and adaptation of the transition from face-to-face to virtual teaching. The absence of programs to prepare for this educational transition can directly impact the education of students. Therefore, students must understand and take full responsibility for their learning needs, goals, and strategies 16.
Contrary to our results, Olmes et al. found a high acceptance and even liking of the online courses. Although presenting a small sample of medical students, almost 3/4 of their sample were looking forward to receiving more online courses. Most students referred to miss actual patients during classes and commented that online classes could not replace patient contact in the hospital preferred traditional lectures. 21. A study made in 2018 compared the grades of a sample of medical students, alternating the use of live and prerecorded classes in a preparation course. 22 The authors found similar results for both groups, although no students received exclusive live or video lectures. Our sample not only preferred presential classes, but they also perceived a lower performance and grades when compared to the pre-pandemic era.
Whether and how stress can positively or negatively affect students' academic performance is not clear, although there are different theories to explain this. In a study of nursing students that assessed the impact of stress factors and depressive symptoms on academic performance, higher stress rates were associated with better individual semester performance, which suggests a positive impact of stress on academic performance 23. Nevertheless, academic performance may be more susceptible because depressive symptoms can interfere with intellectual activity, contributing to school failure 24. Our results are consistent with Rojas Garcia and Ruggero because most of our students reported that their academic performance worsened at the beginning of the online classes, and they perceived worse grades than before. These findings suggest that negative emotions and online learning required because of the pandemic probably played an essential role in creating psychological distress, which may have interfered with students' ability to manage their educational responsibilities during this time.
The sudden outbreak of COVID-19 has inevitably caused anxiety, depression, and other stress reactions among the general population and limited daily life and social activities for an unknown period 7. Our study found that more than 80% of our student sample were distressed and had mild to severe anxiety and depression after the beginning of the COVID-19 outbreak. This prevalence is higher than that reported by a study in the U.S. 1 month after the declared state of emergency, where at least one-third of young adults reported having clinically elevated levels of depression and anxiety 25. A study of 7,143 students in China reported that 24.9% experienced some degree of anxiety: 0.9% experienced severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety 26. Our sample had a higher prevalence of anxiety; most students reported experiencing anxiety, and more than one-fifth of the students met the cutoff scores for each category of mild, moderate, and severe anxiety. This finding indicates that the pandemic has had a negative psychological impact on university students in Mexico.
In a study of 1,826 German university students, the sudden change from face-to-face teaching to online delivery resulted in digital inequality. Two groups were found in the sample: students with excellent preconditions for studying in a digital format, such as access to equipment and skills for participating, and problematic preconditions related to other aspects of disadvantage. This latter group was found to have higher scores for tension, overload, worries, and emotional loneliness and to experience more significant stress 27.
In our sample, severe scores for anxiety and depression were more prevalent than mild scores. These findings are consistent with that of a study of Spaniard university students in which 34.1% of participants reported moderate to severe depression, 21.3% reported moderate to severe anxiety symptoms, and 50.4% of their symptoms were related to a moderate or severe psychological impact during the outbreak and lockdown 28. Only 11% of our students referred to themselves as emotionally stable, which is an alarmingly low percentage and shows the importance of providing psychological resources to address social isolation during the pandemic until regular activity resumes.
The academic performance of our sample was explored using the ASCS. Academic self-concept can be described as the self-perception of one's capabilities or competence in the academic field. This scale has been used to measure secondary education students' performance 17,29. The authors of the scale suggest that a helpful home environment can elevate the students' academic performance. This situation is particularly relevant to our study because the participants in our sample were attending classes online, and some did not live in a helpful or harmonic environment; for example, many households do not have a specialized area for study. Besides, other family members in the house may contribute to distractions or interruptions during class time.
Our sample reported lower academic self-concept scores than those reported in first-year college students 30. When exploring the students' mental state in our sample, we found that the higher the PHQ-9 or GAD-7 scores, the lower the ASCS total scores. However, we also found that the participants who met the cutoff scores for moderate anxiety and severe anxiety for the GAD-7 scores presented similar scores in the Effort and Confidence subscales and ASCS overall scores. Although the students with moderate and severe anxiety had lower scores than those with no or minimal anxiety, it seems that the higher levels of anxiety are associated with a similar level of effort. Some students noted that anxiety and stress often inspired them to put in greater effort in their studies.