In the last two years since the beginning of the COVID 19 pandemic, which has then spread around the world, several studies have been conducted to assess how this new scenario is affecting people's mental health and behavior1. In an attempt to reduce the transmission of severe acute respiratory syndrome due to coronavirus 2 (SARS-CoV-2), globally, individuals have been placed under some type of restriction. Governments worldwide have implemented various modalities of physical distancing measures with varied stringency levels and timeliness. In Italy, similar to many other countries, nationwide measures such as lockdown, quarantine, restricted mobility and physical distancing were introduced in order to contain the rapid spread of the coronavirus. A range of measures has been urgently taken by the government. These challenges along with the difficulties of daily life activities, has raised concerns regarding the possible repercussions on the physical and mental health of people around the world2.
Fear of contagion, deaths from COVID-19, social isolation, limitations in mobility as well as related economic difficulties have been impacting people's lives worldwide and, in many cases, has exceeded individual's adaptive resources with possible repercussions on the their physical and mental health.
Reviews of the current literature1,3,4 have shown that common psychological reactions to the COVID-19 pandemic and its consequences include symptoms of stress, depression, anxiety and sleep difficulties. In particular, a worsening of anxiety and depressive symptoms as well as lower psychological well-being were found in studies comparing measurements taken before and after the pandemic outbreak5. Furthermore, a worsening of psychiatric symptoms in patients who suffered from pre-existing mental disorders has been described6. Consequently, psychological distress affects the general population leading to impairments that vary based on different risk and protective factors4. University students may be significantly affected by this huge amount of stressors. Indeed, it is widely known in the scientific literature that emotional and psychological distress, with prevalence of anxiety and depressive symptoms, are common among university students7,8. Dealing with academic duties adds a load of stress on young people who are already facing the developmental tasks characteristic of emerging adulthood9,10. Indeed, this stage of life is characterized by increased vulnerability as shown by the fact that the onset of most psychiatric disorders occurs between adolescence and early adulthood11,12,13. In recent years, there has been a growing interest in research on university students seeking psychological help for their mental health issues. Findings have highlighted how clinical symptoms and psychological distress have important implications for academic functioning14,15. Certainly, the current pandemic scenario may adversely affect psychological well-being, of university students. In fact, university settings have been involved in the abovementioned restrictions with the closure of classrooms, research laboratories and the cancellation of academic events, while teaching and learning activities were carried out online. Furthermore, widespread fears could restrict one's sense of self-agency and have a significant impact on student’s perceived academic self-efficacy16 which, in turn, may lead to higher levels of psychological distress17. Among young people, female students have shown higher levels of depression, anxiety and/or psychological distress18,19,20,21. Specifically, as regards the impact of the COVID-19 pandemic on young people, a recent study has revealed that young people aged 21–40 years are in a more vulnerable position in terms of their mental health22. Findings from the first investigation on college students carried out in China23 highlighted that 0.9% of 7,143 respondents were experiencing severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety. In comparison, the first study to focus on the impact of lockdown and quarantine on the mental health of university students attending different faculties was performed in Greece24. The findings showed high levels of anxiety (42.5%); depression (74.3%) and an increase in total suicidal thoughts (63.3%) among the students who participated in the study. Moderate to extreme severity scores for anxiety, depression and stress were reported by 21.34%, 34.19% and 28.14% of Spanish university students respectively25. In a recent meta-analysis involving twenty-seven studies conducted in 15 different countries, Batra and colleagues26 analysed the psychological impact of the COVID-19 pandemic among college students. They observed a prevalence of anxiety (39,4%), depression (31,2%), stress (26.0%), post-traumatic stress disorder (29.8%) and impaired sleep quality (50.5%) with females reporting higher levels of anxiety and depression than males. Similar results were found in an Italian study27 that showed how university students reported higher levels of both anxiety and depressive symptoms than general workers. Gender differences were also observed with females suffering from higher levels of these symptoms compared to males.
Consistently, some researchers have compared measures of psychological distress before and after the pandemic outbreak within samples of university students finding significant increments in symptoms of anxiety and depression18, mood disorder symptoms, perceived stress, alcohol use28, externalizing and attention problems29 and a significant decrease in mental well-being and physical activity30. Nevertheless, there are few studies that have investigated the psychological impact of COVID-19 among university students seeking help at University Counselling Centers. The results of an Italian study30 highlighted high levels of anxiety and stress, concentration difficulties and somatization in a sample of university students seeking psychological support at a University Counselling Center during the COVID-19 lockdown.
In contrast, a research study carried out in a US University Counselling Center31, found that students attending counselling sessions in 2020 were not significantly more distressed than students in the previous 3 years as evaluated by the Outcome Questionnaire 4532. However, the authors of the study reported that students’ scores showed a trend in the direction of higher distress during 2020 than during the previous years. These difference may be partially explained by the minor restrictions that have been adopted in the US.
In light of the above, the main objective of this study was to examine differences in clinical symptoms and psychological distress in two groups of university students seeking help at XXX Psychological Counselling Center, University of XXX prior to the COVID-19 pandemic (May 2019 - January, 2020) and during the COVID-19 pandemic (May 2020 - January 2021). Based on recent studies among university students, we hypothesized that university students who were referred to the Psychological Counselling Center during the COVID-19 pandemic would report higher clinical symptoms than those students who were referred prior to the COVID-19 pandemic. Regarding psychological distress, our study was exploratory in nature given the lack of existing empirical findings. However according to the international literature that showed the negative impact of the COVID-19 pandemic on psychological distress of both general and clinical populations we hypothesized that a greater level of psychological distress can emerge in students who were referred to the Psychological Counselling Center during the COVID-19 pandemic compared to the pre-pandemic ones.