Sample and Participants
Table 1 presents the demographic characteristics of the sample (n= 4 954). The largest percentage of participants were female (74.3%), between 18 and 20 years of age (42.7%), and were studying at the undergraduate level (78.2%). The average age was 23.4 years of age (SD= 6.9). About 12% of students in this sample were international students, and 27% identified as being first generation university students (the first in their immediate family to attend university). Our sample included students attending university in Atlantic, Central, and Western Canada.
Table 1
Demographic Characteristics of Sample (N = 4954)
Variable
|
n
|
%
|
Region of Institution
|
|
|
Atlantic Canada
|
2014
|
40.8
|
Central Canada
|
972
|
19.7
|
Western Canada
|
1952
|
39.5
|
Sex
|
|
|
Male
|
1240
|
25.7
|
Female
|
3584
|
74.3
|
Age
|
|
|
18-20 years
|
2116
|
42.7
|
21-24 years
|
1546
|
31.2
|
25-29 years
|
635
|
12.8
|
30+ years
|
654
|
13.2
|
Level of Study
|
|
|
Undergraduate
|
3774
|
78.2
|
Graduate
|
889
|
18.4
|
Professional Program
|
166
|
3.4
|
Student Status
|
|
|
International
|
585
|
11.8
|
Domestic
|
4358
|
88.2
|
First Generation Status
|
|
|
Yes
|
1330
|
27.0
|
No
|
3595
|
73.0
|
Note. Valid percentages displayed (missing data not included in denominator). |
Univariate Analyses
Table 2 displays the descriptive statistics for variables related to COVID-19. Of the thirteen COVID-19 related stressors, the highest mean ratings were observed among uncertainty around the pandemic’s effect on academics (i.e., having to enrol in mandatory online classes) (X̅= 2.76, SD= 1.06) and uncertainty around how long the pandemic might last (X̅ = 2.68, SD= 0.95). Concerns around family members or friends contracting the virus, loneliness stemming from quarantine/self-isolation, and concerns about others not following safety protocols also appeared to be considerable sources of stress (X̅ = 2.46 - 2.55). Students appeared to be least concerned about ensuring they themselves were effectively following safety
Table 2
Descriptive Statistics for COVID-19 Related Stressors
Variable
|
|
|
n (%)
|
|
|
|
COVID-19 Related Stressors
|
0
N/A or Didn’t happen
|
1
Not stressful
|
2
Somewhat Stressful
|
3
Very Stressful
|
4
Extremely stressful
|
Mean (SD)1
|
1. Uncertainty around length of pandemic
|
58 (1.2)
|
527 (10.6)
|
1680 (33.9)
|
1527 (30.8)
|
1161 (23.4)
|
2.68 (0.95)
|
2. Loneliness as a result of quarantine/self-isolation
|
425 (8.6)
|
1040 (21.0)
|
1335 (27.0)
|
1153 (23.3)
|
998 (20.2)
|
2.47 (1.07)
|
3. Worrying a family member/friend will contract COVID-19
|
160 (3.2)
|
852 (17.2)
|
1623 (32.8)
|
1154 (23.3)
|
1161 (23.5)
|
2.55 (1.04)
|
4. Worrying that I will contract COVID-19
|
193 (3.9)
|
1778 (35.9)
|
1656 (33.5)
|
743 (15.0)
|
579 (11.7)
|
2.03 (1.01)
|
5. Returning to school during COVID-19
|
623 (12.6)
|
1271 (25.7)
|
1467 (29.7)
|
890 (18.0)
|
696 (14.1)
|
2.23 (1.04)
|
6. COVID-19’s effect on my employment/finances
|
515 (10.4)
|
1028 (20.8)
|
1421 (28.7)
|
983 (19.9)
|
1004 (20.3)
|
2.44 (1.08)
|
7. Difficulties accessing physical/mental health career as a result of COVID-19
|
822 (16.6)
|
1372 (27.7)
|
1333 (26.9)
|
753 (15.2)
|
669 (13.5)
|
2.17 (1.06)
|
8. COVID-19’s effect on your living situation
|
852 (17.2)
|
1717 (34.7)
|
1214 (24.5)
|
636 (12.9)
|
527 (10.7)
|
1.99 (1.04)
|
9. Ensuring I am effectively following COVID-19 safety protocols
|
123 (2.5)
|
1976 (39.9)
|
1834 (37.1)
|
668 (13.5)
|
348 (7.0)
|
1.87 (0.91)
|
10. People around me not effectively following COVID-19 safety protocols
|
154 (3.1)
|
798 (16.1)
|
1620 (32.7)
|
1271 (25.7)
|
1104 (22.3)
|
2.56 (1.02)
|
11. COVID-19’s effect on your academics (i.e., mandatory online classes)
|
152 (3.1)
|
729 (14.7)
|
1207 (24.4)
|
1343 (27.1)
|
1518 (30.7)
|
2.76 (1.06)
|
12. COVID-19’s effect on your ability to graduate “on time”
|
766 (15.5)
|
1474 (29.8)
|
1072 (21.7)
|
766 (15.5)
|
864 (17.5)
|
2.24 (1.14)
|
13. COVID-19’s effect on your ability to obtain employment after graduating
|
782 (15.8)
|
1091 (22.0)
|
1085 (21.9)
|
907 (18.3)
|
1083 (21.9)
|
2.48 (1.14)
|
COVID-19 Diagnosis History
|
Yes
|
No
|
Unsure
|
|
|
|
Personally contracted COVID-19
|
31 (0.6)
|
4719 (95.9)
|
172 (3.5)
|
|
|
--
|
Friend/family member contracted COVID-19
|
791 (16.0)
|
3976 (80.3)
|
184 (3.7)
|
|
|
--
|
protocols (X̅ = 1.87, SD= 0.91) and the effect of the pandemic on their living situation (X̅ = 1.98, SD= 1.04). Of those who provided an answer to questions about their COVID-19 mental illness diagnosis
history, 0.6% of the sample (n= 31) reported that they had personally contracted the virus, while 16% (n= 791) reported that either a friend or family member had.
Descriptive statistics for the mental health variables are presented in Table 3. The average resilience score for the sample was 26.20 (SD= 6.32), indicating a moderate level of resilience, which is consistent with the scale average observed in other Canadian student populations (30). The average psychological distress score for the sample was 28.67 (SD= 9.53). Based on the recommended cut points for scores indicative of likely experiencing a mental disorder, 17.8%, 18.0%, and 45.0% of the sample were likely to have a mild, moderate, and severe mental disorder, respectively. Only 19.2% of the sample scored low enough on the K10 to suggest they were “likely to be well” (n= 951). Finally, 30.8% of the sample (n= 1483) reported having a pre-existing, diagnosed mental illness.
Table 3
Descriptive Statistics for Mental Health Variables
Mental Health Variables
|
n (%)
|
Mean (SD)
|
Psychological distress (K10)1
|
|
28.67 (9.53)
|
Likely to be well (score 10-19)
|
951 (19.2)
|
|
Mild disorder (score 20-24)
|
879 (17.8)
|
|
Moderate disorder (score 25-29)
|
892 (18.0)
|
|
Severe disorder (score 30-50)
|
2227 (45.0)
|
|
Resilience (CD-RISC-10)2
|
|
26.20 (6.32)
|
Low resilience (score ≤26)
|
2543 (51.4)
|
|
High resilience (score >26)
|
2407 (48.6)
|
|
Note. 1 Categories correspond to recommended cut points for scores on the K10 indicative of |
“likely mental disorder”. Total K10 scale score ranges from 10-50.
2 Total CD-RISC-10 scale score ranges from 0-40.
Multivariable Analyses
As expected, resilience was found to be an effect modifier of the relationship between COVID-19 related stressors and psychological distress (Appendix B). As such, we stratified our sample by high and low resilience.
All COVID-19 related stressors were significantly associated with an increase in the likelihood of screening positive for at least a moderate mental disorder. Table 4 displays the results for adjusted and unadjusted models. Within the low resilience stratum, the strongest associations were observed for the following stressors: COVID-19’s effect on my academics (RR= 1.14 [95% CI 1.08, 1.20]); difficulties accessing mental/physical health care during the pandemic (RR= 1.12 [95% CI 1.07, 1.18]); and loneliness as a result of quarantine/self-isolation (R= 1.11 [95% CI 1.06, 1.16]). Within the high resilience stratum, the strongest associations were observed for: COVID-19’s effect on my academics (RR= 1.32 [95% CI 1.25, 1.41]); difficulties accessing mental/physical healthcare during the pandemic (RR= 1.25 [95% CI 1.18, 1.33])); and uncertainty around how long the pandemic will last (RR= 1.24 [95% CI 1.16, 1.32]). Overall, larger effects were observed for those in the high resilience stratum compared to those in the low resilience stratum.
Table 4
Unadjusted and adjusted models for relationship between COVID-19 stressor variables and positive K10 screen for at least a moderate mental disorder, stratified by level of resilience
|
LOW RESILIENCE
|
HIGH RESILIENCE
|
Stressor
|
Unadjusted
RR (95% CI)
|
Adjusted1
RR (95% CI)
|
Unadjusted
RR (95% CI)
|
Adjusted1
RR (95% CI)
|
Uncertainty around how long the pandemic
will last
|
1.12 (1.06, 1.17)
|
1.10 (1.04, 1.16)
|
1.30 (1.23, 1.38)
|
1.24 (1.16, 1.32)
|
Loneliness as a result of quarantine/self-isolation
|
1.13 (1.08, 1.18)
|
1.11 (1.06, 1.16)
|
1.29 (1.23, 1.37)
|
1.23 (1.16, 1.31)
|
Worrying a family member/friend will contract COVID-19
|
1.08 (1.03, 1.13)
|
1.07 (1.02, 1.12)
|
1.20 (1.14, 1.27)
|
1.16 (1.10, 1.23)
|
Worrying that I will contract COVID-19
|
1.06 (1.02, 1.11)
|
1.05 (1.01, 1.10)
|
1.17 (1.10, 1.23)
|
1.12 (1.06, 1.19)
|
Returning to school during COVID-19
|
1.09 (1.05, 1.15)
|
1.08 (1.03, 1.13)
|
1.24 (1.17, 1.31)
|
1.18 (1.11, 1.25)
|
COVID-19’s effect on my employment/finances
|
1.10 (1.06, 1.15)
|
1.10 (1.05, 1.15)
|
1.26 (1.19, 1.33)
|
1.22 (1.15, 1.29)
|
Difficulties accessing physical/mental health care as a result of COVID-19
|
1.14 (1.09, 1.19)
|
1.12 (1.07, 1.18)
|
1.34 (1.27, 1.42)
|
1.25 (1.18, 1.33)
|
COVID-19’s effect on your living situation
|
1.09 (1.05, 1.14)
|
1.10 (1.05, 1.15)
|
1.25 (1.18, 1.33)
|
1.20 (1.13, 1.28)
|
Ensuring I am effectively following COVID-19 safety protocols
|
1.10 (1.05, 1.15)
|
1.09 (1.04, 1.14)
|
1.25 (1.18, 1.33)
|
1.20 (1.13, 1.28)
|
People around me not effectively following COVID-19 safety protocols
|
1.09 (1.04, 1.14)
|
1.07 (1.02, 1.12)
|
1.22 (1.15, 1.29)
|
1.14 (1.07, 1.21)
|
COVID-19’s effect on your academics (i.e., mandatory online classes)
|
1.15 (1.10, 1.21)
|
1.14 (1.08, 1.20)
|
1.39 (1.31, 1.47)
|
1.32 (1.25, 1.41)
|
COVID-19’s effect on your ability to graduate “on time”
|
1.10 (1.06, 1.15)
|
1.10 (1.05, 1.15)
|
1.24 (1.18, 1.31)
|
1.21 (1.15, 1.28)
|
COVID-19’s effect on your ability to obtain employment after graduating
|
1.07 (1.03, 1.12)
|
1.08 (1.03, 1.13)
|
1.23 (1.16, 1.29)
|
1.21 (1.15, 1.28)
|
Notes. (1) Models adjusted for the effects of: age, sex level of study, international student status, first generation student status, region of institution, and friend/family member COVID-19 diagnosis, and personal diagnosed mental illness. (2) Low resilience group defined as those who scored below the mean for the sample (score ≤26), high resilience group defined as those who scored at the mean or higher (score >26). (3) Top three largest associations in adjusted models are bolded. |