The Impact of Covid-19 on College Student Well-Being

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING

The Healthy Minds Network, which runs the Healthy Minds Study (HMS), in collaboration with the American College Health Association, which runs the National College Health Assessment (ACHA- NCHA), developed a new set of survey items related to students’ experiences with the COVID-19 pandemic. The new items focused on students’ attitudes, concerns, preventive behaviors, and their perceived supportiveness of colleges and universities related to COVID-19. These items were fielded to random samples of college students on participating campuses across the United States between March and May 2020.

This brief data report presents results from 18,764 students on 14 campuses that participated in the surveys from late March through May 2020. The report is organized as follows:

Summary Campus and student characteristics (Table 1) COVID-19 prevalence and susceptibility (Figures 1-2) Students’ concerns related to the pandemic (Figure 3) Non-health impacts of COVID-19 (Figures 4-7) Hygiene and physical distancing behaviors among students (Figure 8) Trusted sources of information (Figure 9) Supportiveness of campus response (Figure 10) Mental health and substance use pre/post pandemic (Figure 11)

Notes: Response rates are a key limitation. For HMS, the overall response rate from March-May 2020 was 10.3%, significantly lower than in previous semesters. Similarly, for ACHA-NCHA, the overall response rate from March-May 2020 was 9.3%. We used data for each participating institution on the proportion of male/female students and used these to create sample weights that account for the sex distribution in the full campus population. The weighted estimates are representative of the full student population in terms of the sex variable available for each institution. We gave the same aggregate weight to each institution in the sample to ensure that larger campuses were not overrepresented in the results.

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 1 Summary – Financial stress, a known predictor of student mental health, has been significantly affected by the pandemic: two-thirds of students report their financial situation has become more stressful. Roughly one-third of students report that their living situation changed as a result of the pandemic.

– Fifteen percent report a probable case of COVID-19, though less than 1% were confirmed by a test. Sixty percent perceive themselves to be susceptible to contracting the virus. Students are concerned about their personal safety and security, but even more so about people they care about contracting the virus. Students also express high levels of concern about how long the pandemic will last.

– The majority of students report following public health guidelines for handwashing (60%) and physical distancing (70%). Eighty-four percent of students report public health agencies are among their most trusted sources of information about the pandemic.

– Forty percent of students report witnessing race-based discrimination either in person or online. – Students report that their campuses have generally been supportive, especially professors. – Sixty percent of students indicate that the pandemic has made it more difficult to access mental health care. – Symptoms of mental health conditions remain high in college student populations, both before and after the start of the pandemic. Relative to fall 2019, the prevalence of depression increased and substance use decreased in spring 2020. In March through May 2020, a higher proportion of students report that their mental health negatively impacted their academic performance. While students report lower levels of psychological wellbeing post-pandemic relative to Fall 2019, they also reported higher levels of resiliency.

Campus and Student Characteristics A total of 14 colleges and universities participated in the two studies between March and May 2020: 7 for HMS and 7 for ACHA-NCHA. The characteristics of these institutions and their students are presented in Table 1 overall and for HMS and ACHA-NCHA separately.

Table 1a: Overall HMS ACHA-NCHA Campus Characteristics (N=14 campuses) (N=7 campuses) (N=7 campuses) Institutional size: >20,000 9 6 3 Institutional size: 10-19,999 4 1 3 Institutional size: 5-9,999 0 0 0 Institutional size: 2,500-4,999 0 0 0 Institutional size: <2,500 1 0 1 Public 12 6 6 Private 2 1 1 2-year 1 1 0 4-year 13 6 7 Geographic region: Northeast 5 4 1 Geographic region: Midwest 3 1 2 Geographic region: Southern 2 1 1 Geographic region: Western 4 1 3

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 2 Summary (continued)

Table 1b: Overall HMS ACHA-NCHA Student Characteristics (N=18,764 students) (N=12,033 students) (N=6731 students)

Age 18-24 68.6% 69.2% 67.9% Undergraduate 70.4% 66.4% 74.6% Gender identity: female 52.3% 51.2% 52.9% Gender identity: male 44.9% 46.8% 42.7% Gender identity: transgender/gender 2.7% 2.0% 3.5% nonconforming/self-identified gender Race/ethnicity: Black 7.9% 9.3% 6.5% Race/ethnicity: Latinx 13.3% 16.7% 10.0% Race/ethnicity: Asian 16.7% 20.8% 12.7% Race/ethnicity: Middle Eastern/Arab/ 2.2% 2.8% 1.7% Arab American Race/ethnicity: White 64.2% 57.3% 71.2% Race/ethnicity: Other 6.2% 1.4% 8.8% International student 10.2% 11.7% 9.0%

Notes: For HMS, “other” race includes American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, and those who selected self-identified race/ethnicity. For NCHA, “other” race includes bi/multiracial, Native Hawaiian/other Pacific Islander, and American Indian/Native Alaskan.

COVID-19 Prevalence Less than 1% of students report having a confirmed case of COVID-19. Among those with a confirmed or probable case, 5.5% reported their symptoms as severe, 35.1% as moderate, 55.3% as mild, and 4.1% as asymptomatic.

Figure 1. Have you had COVID-19 (the novel coronavirus disease)? 100 84.7 80

20 13 0.6 1.7 0 Yes, confirmed by test Probably (healthcare Maybe (had symptoms No (no symptoms or other provider told me I likely consistent with COVID-19, reason to think I have had had COVID-19, but not but not confirmed by test) it) confirmed by test)

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 3 Perceived Susceptibility Sixty percent of students with no prior symptoms of COVID-19 consider it very likely, likely, or somewhat likely that they will be infected.

Figure 2. How likely do you think it is that you will develop COVID-19?

2.7 8.4

Very likely 40.3 Likely Somewhat likely Not at all likely 48.6

Concerns about the Future Sixty-five percent of students report being very or extremely concerned about how long the pandemic will last, while 64% report being very or extremely concerned about people they care about contracting COVID-19. Eighty-six percent report concerns about their personal safety and security.

Figure 3a. Over the past 2 weeks, on average, how much have you been concerned with the following? 100

80 64.8 64.4 60 52.9 42.4 40 32 33.3

20 3.2 4.7 2.5 0 How long the pandemic will last How many more people wiill People you care about contracting become infected COVID-19

Not at all Slightly/moderately Very/extremely

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 4 Concerns about the Future (continued)

Figure 3b. Over the past 2 weeks, on average, how much have you been concerned with the following? 100

57.4 60 53.1

40 33.3 25.8 16.9 20 13.5

0 Your personal sense of safety and security Personally contracting COVID-19

Not at all Slightly/moderately Very/extremely

Financial Effects Sixty-six percent report that the pandemic has resulted in more financial stress.

Figure 4. How has your financial situation been affected by the COVID-19 pandemic? 100

60 39.6 40 26.4 29.2 20 4.8 0 A lot more stressful Somewhat more No significant change Less stressful stressful

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 5 Housing Stability Thirty-six percent of students report moving to a new living situation as a result of the pandemic.

Figure 5. Have you moved to a new living situation as a result of the COVID-19 pandemic? 100

80 64.3 60

40 35.7

0 Yes No

Mental Health Care Sixty percent of students indicate that the pandemic has made it more difficult to access mental health care.

Figure 6. How has your access to mental health care been affected by the COVID-19 pandemic? 100

60 36.8 40 34.9 23.3 20 5.1 0 Much more difficult Somewhat more difficult No significant change in Less difficult access

Notes: Overall, 58.2% of students indicated that they have not tried to access mental health care. Figure 6 presents data from the 41.8% of students who did attempt to seek care.

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 6 Discrimination Six percent report experiencing race-based discrimination as a result of the pandemic, while 41% report witnessing race-based discrimination (online or in person).

Figure 7a. As a result of the pandemic, Figure 7b. As a result of the pandemic, have you experienced any discriminatory have you witnessed any discriminatory or hostile behavior due to your or hostile behavior or exchanges towards race/ethnicity? others due to their race/ethnicity? 5.5

94.5

Yes No Yes No

Public Health Practices 60 percent of students report very closely following recommended hygiene practices, while 70% report physical distancing.

Figure 8. To what extent have you been following recommendations for... 100

80 69.7 60.2 60

36.8 40 26.9

20 2.7 0.4 2.6 0.8 0 ...hygiene practices? ...social/physical distancing?

Very closely Somewhat closely Not closely Not all following

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 7 Sources of Information Eighty-four percent of students report that public health agencies are among their most trusted sources of information, making this the most trusted source overall. Thirty-six report that campus officials are a most trusted source.

Figure 9. What have been your most trusted sources of information regarding the COVID-19 pandemic (select up to 3)? 100 84 80

60 53.2 50.8

40 35.6 34.4 27.8 26.7 23.4 21.1 20

0 Public health National media State/local Campus Friends/family Social media Federal Local media Other agencies officials officials officials

Supportiveness of Campus Sixty-nine percent of students report that their campus administration has been supportive during the pandemic, and 78% perceived their professors as being supportive.

Figure 10. How supportive have the following groups been for you during the COVID-19 pandemic? 100 80 60 39.6 40.1 37.5 34.5 40 29 31.9 21.3 24.4 22.7 22.9 15.1 9.6 13.1 10.1 13.1 20 8.7 7.7 4.6 7.3 6.9 0 College/university Your professors Campus mental health Campus medical services administration services

Unsupportive Neutral Supportive Very supportive N/A

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 8 Mental Health and Substance Use Pre-/Post-Pandemic Symptoms of mental health conditions remain high in college student populations, both before and after the start of the pandemic. Relative to fall 2019, the prevalence of depression increased and substance use decreased in spring 2020. In March through May 2020, a higher proportion of students report that their mental health negatively impacted their academic performance. While students report lower levels of psychological well-being post-pandemic relative to Fall 2019, they also reported higher levels of resiliency.

Figure 11a. Mental Health and Substance Use Fall 2019 vs. Spring 2020 (Healthy Minds Study) 100 80 60 40.9 35.7 38.1 36.6 38.3 31 31 30.5 40 26.3 24.1 21.9 20.9 17.7 20.9 20 0 Depression Suicidal ideation, Anxiety Flourishing Illicit substance Binge drinking, MH impaired past 2 weeks use, past month past 2 weeks academics, 6+ days in last 4 weeks

Fall 2019 March-May 2020

Notes: There were 32 campuses in HMS in fall 2019 and 7 campuses in March-May 2020. Depression is a score of >10 on the Patient Health Questionnaire-9 (PHQ-9), which measures the 9 core symptoms of a major depressive episode over the past 2 weeks. Suicidal ideation over the past 2 weeks is one item from the PHQ-9, defined as having “thoughts that you would be better off dead or of hurting yourself in some way.” Anxiety is a score of >10 on the Generalized Anxiety Disorder 7-scale, which measures symptoms of generalized anxiety over the past 2 weeks. Flourishing (positive mental health) is a score of >48 on the Flourishing Scale. MH impaired academics is defined as >6 days in the last 4 weeks when mental or emotional health negatively impacted academic performance.

THE IMPACT OF COVID-19 ON COLLEGE STUDENT WELL-BEING Page 9 Mental Health and Substance Use Pre-/Post-Pandemic (continued)

Figure 11b. Mental Health and Substance Use Fall 2019 vs. Spring 2020 (ACHA-NCHA) 100 80 55.9 60 49.5 47 50.8 36.5 39 31.1 40 25 27.2 26.8 27.8 24.4 19.2 17.8 19.1 22.1 20 0 Suicide risk Serious Loneliness Resilience Flourishing Binge Anxiety Depression Psychological drinking, past impaired impaired Distress 2 weeks academics academics

Fall 2019 March-May 2020

Notes: Fall 2019 includes 38,679 students on 58 campuses. March-May 2020 includes 8,366 students on 16 campuses. Being at increased risk for suicide is a score of 7 or higher on the Suicide Behavior Questionnaire – Revised (SBQ-R). Serious psychological distress is a score of 13 or higher on the Kessler-6 (K6.) Screening positive for loneliness is a score of 6 or higher on the 3-item UCLA Loneliness Scale. Resilience is a score of 7 or higher on the Connor-Davidson Resiliency Scale – 2 (CD-RISC2). Flourishing (positive mental health) is a score of >48 on the Diener Flourishing Scale. Academic impediments include negatively impacting performance in a class or delaying progress towards a degree and are measured within the last 12 months.

CONTACT The Healthy Minds Network: [email protected] ACHA-NCHA: [email protected]

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