Prevalence of depressive symptoms and psychological distress in Japanese university-enrolled students before and during the coronavirus disease 2019 pandemic
This study is intended to ascertain whether a difference exists in depressive symptoms and psychological distresses among first-year university students before and during the influence of the coronavirus disease 2019 (COVID-19) pandemic.
New students at Hokkaido University participated before COVID-19: 1935 students from 2016 and 1717 students from 2017. During COVID-19, 1087 students were included from 2020. As part of their entrance orientation, participants were administered the Patient Health Questionnaire–9 (PHQ-9) to measure depressive symptoms1, 2 and the Kessler Psychological Distress Scale–10 (K-10) to measure psychological distress based on their responses to questions about anxiety and depressive symptoms.3, 4 Age at admission, sex, hometown, and residence after enrollment were also elicited.
All participants gave consent for the use of anonymized data and for the use of results for research activities aimed at improving health activities. Ethical approval for collection of these data was obtained from the ethical committee of Hokkaido University Graduate School of Medicine (approval number: 12-002).
Analyses were conducted using SPSS version 23 for Mac OS (IBM). Significance was inferred for P < 0.05 (two-tailed).
Demographic characteristics of participants are presented in Table S1. No significant difference was found among new students of the 2016, 2017, and 2020 academic years in terms of the ratio of men to women, whether they lived with family members, or whether they were from Hokkaido. However, a significantly higher rate of students who were 18 years old at the time of enrollment was found for new students in the 2020 academic year.
Considering moderate or more depressive symptoms (10 points or more on PHQ-9), 127 of 3652 students (3.5%) had depressive symptoms before COVID-19, and 114 of 1087 students (10.5%) had depressive symptoms during COVID-19. The prevalence of depressive symptoms among students was higher for every category during COVID-19 than before COVID-19 (Table 1).
| % (95%CI) | Difference | |||||
|---|---|---|---|---|---|---|
| Depressive symptoms | Before COVID-19 Mean (SD); 2.5 (3.1) | During COVID-19 Mean (SD); 4.4(4.2) | Absolute, % | Relative | ||
| None | 81.1 | (79.8–82.4) | 61.5 | (58.5–64.4) | −19.6 | 0.8 ** |
| Mild | 15.4 | (14.2–16.6) | 28.1 | (25.4–30.8) | 12.7 | 1.8 ** |
| Moderate | 2.9 | (2.4–3.5) | 6.8 | (5.4–8.5) | 3.9 | 2.3 ** |
| Moderately severe | 0.4 | (0.2–0.6) | 2.7 | (1.8–3.8) | 2.3 | 6.8 ** |
| Severe | 0.2 | (0.1–0.4) | 1.0 | (0.5–1.8) | 0.8 | 5.0 * |
| Above moderate | 3.5 | (2.9–4.1) | 10.5 | (8.7–12.5) | 7.0 | 3.0 ** |
| Psychological distresses | Mean (SD); 6.1 (6.2) | Mean (SD); 5.3 (6.3) | ||||
| Low | 77.1 | (75.7–78.4) | 80.5 | (78.0–82.8) | 3.4 | 1.0 |
| Mild | 12.5 | (11.4–13.6) | 11.1 | (9.3–13.2) | −1.4 | 0.9 |
| Moderate | 6.1 | (5.3–6.9) | 4.0 | (2.9–5.3) | −2.1 | 0.7 * |
| Severe | 4.4 | (3.7–5.1) | 4.4 | (3.3–5.8) | 0.0 | 1.0 |
| Above moderate | 10.4 | (9.4–11.4) | 8.4 | (6.8–10.2) | −2.0 | 0.8 |
| Depressive symptoms (none or mild) and psychological distress (low or mild) | ||||||
| 88.5 | (87.4–89.5) | 87.4 | (85.3–89.3) | −1.1 | 1.0 | |
- CI, confidence interval; COVID-19, coronavirus disease 2019.
- Percentages represent the number of the total number of participants.
- Depressive symptoms were assessed using the Patient Health Questionnaire–9 (PHQ-9) and categorized as none (score, 0–4), mild (score, 5–9), moderate (score, 10–14), moderately severe (score, 15–19), and severe (score, ≥20). Depressive symptoms defined as PHQ-9 score not less than 10. Psychological distresses were assessed using the Kessler Psychological Distress Scale–10 (K-10) and categorized as low (score, 0–9), mild (10–14), moderate (score 15–19), and severe (score, ≥20). Psychological distresses were defined as a K-10 score not less than 15. Depressive symptoms (none or mild) and psychological distress (low or mild) indicate that the participant is unlikely to have clinical problems.
- * P < 0.05.
- ** P < 0.01.
However, regarding moderate or greater psychological distress (score of 15 or higher on K-10), students with psychological distress comprised 380 of 3652 (10.4%) before COVID-19 and 91 of 1087 (8.4%) during COVID-19. The relative degrees of psychological distress before and during COVID-19 did not significantly differ, but responses of the moderate category were fewer.
Results of multiple logistic regression analysis for all 4739 participants are presented in Table S2. When the presence of depressive symptoms was the dependent variable, the odds ratio (OR) for before and during COVID-19 was significant at 3.35, but the ORs for sex and age were not significant, although the OR for life circumstances was significant at 1.39. When the presence of psychological distress was used as the dependent variable, the ORs before and during COVID-19 and for sex were not significant. However, the OR for age was 1.46 and for living environment was 1.37.
Results of this study indicate that while depressive symptoms show greater prevalence in university-enrolled students during the COVID-19 pandemic compared with those before COVID-19, psychological distress is not greater, even after controlling for sex, age at enrollment, and living with family or not. Greater prevalence of depressive symptoms among the general population has been reported, which is consistent with findings obtained from the current study.5, 6 However, overall psychological distress did not increase—a result seemingly contradictory to the increase in depressive symptoms.
According to a systematic review of reports from the early stages of the COVID-19 pandemic, the risk factor for depression include being female while the risk factors for depression and anxiety include being in one's 20s or 30s, having a high school education and having a chronic illness. However, protective factors for depression and anxiety include correct information about the pandemic, resources for necessary medical supplies, positive and optimistic thinking, and supply of counseling applications.7 The present results might reflect the strong role of exacerbating factors for depressive symptoms, whereas protective factors are strong for anxiety symptoms.
Depressive and anxiety symptoms might differ depending on the time of measurement: anxiety became more intense during the first 4 weeks of the COVID-19 pandemic, but it gradually reverted to the level prevailing before the pandemic during the following 8 weeks, consistent with the peak of the pandemic.8 The timing of the survey of 2020 in this study coincided with the time when the first wave of the COVID-19 pandemic tended to subside, which might have been a factor in lowering anxiety symptoms.
This study is based on data obtained from students enrolled in a single university in Japan. One must be cautious about generalizing the results to university students and young adults.
Acknowledgments
This study was supported by Japan Society for Promotion of Science KAKENHI grant number JP18K07583 (SA). The authors are grateful to Hiroko Takeda and Kaai Ishihara, staff members at the Health Care Center of Hokkaido University, for assistance with data collection.
Disclosure statement
The authors declare that they have no conflicts of interest.
