Mental health of university students during the pandemic. Threats to their mental health and proposals for university student support in Poland

INTRODUCTION

A pandemic like the current one of 2020-2022, linked to the new coronavirus strain SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), causing a disease called COVID-19 (coronavirus disease 2019) [1], can be regarded as a crisis and thus potentially a threat to mental health, which is an important element of general health (alongside physical and social health) at every stage of life [2]. Mental health is closely related to physical/ somatic health, among other things, in the context of health behaviours and immunological processes [3]. Thus, any physical illness that is life-threatening and therefore life-altering has a potentially negative impact on a person’s overall mental health [4]. The current pandemic situation and succeeding waves of infections represent a potential additional risk factor for mental health, which is being still observed and analysed [5]. Thus, it is essential to monitor mental health in various population groups precisely in relation to the threat of infection, prevention measures and the treatment of people with COVID-19 [6-10].

This article presents potential difficulties that may occur in the area of mental health in a group of young adults – university students, as well as examples of support that can be implemented at a higher education institution in order to maintain and strengthen the mental health of students during the pandemic, based on a proposal for support introduced at one of the Polish universities between March 2020 and December 2021.

MENTAL HEALTH OF STUDENTS – EPIDEMIOLOGY AND CURRENTLY OBSERVED DIFFICULTIES

Students in Poland are mostly young adults, i.e. people aged 18/21-35. This the time of many developmental challenges connected with the beginning of adult life, e.g., building and maintaining close relationships with other people and acquiring an education/profession [11]. For some students, these tasks may be particularly burdensome; failures may cause severe stress, and undertaking some activities may be associated with strong anxiety. Due to increasing social expectations and present-day challenges to achieving greater financial and life independence – e.g. young people often combine their studies with paid work or live independently for the first time, away from their family home – mental health problems are increasingly observed among students. The extent of the difficulties is evidenced by successive reports from studies monitoring the of the both the entire population and young people only, as well as reports from practitioners (doctors, psychotherapists) whose patients are more and more often people in early adulthood [12-14].

This developmental period is also the time when some mental illnesses appear, e.g., schizophrenia [15]. At the age of 16-24, the first psychotic episodes often occur; these hinder, and sometimes temporarily prevent, young people from adequate social and cognitive functioning. A manifestation of developing mental illness may be problems in relations with others, in the case of students with lecturers or peers; and difficulties in studying, e.g., remembering the material, taking exams, writing assignments, attending classes, and meeting the deadlines of the academic year [16, 17]. Currently there are also more and more students who have been under the care of psychiatrists, psychologists, or psychotherapists for many years [13], e.g. due to autism spectrum disorders (e.g., Asperger’s syndrome). These young people often do very well in their studies, but it is difficult for them to be with their peers, build relationships with them, independently organize their studies, participate in academic classes, and adapt to the rules of social conduct at university [18]. On the one hand, studying gives these young people an opportunity for further development and better functioning if they manage to meet the developmental requirements. It is even a kind of help, a mobilization for action and a fight against the mental health crises they experience. On the other hand, studying can be a source of great stress and many misunderstandings when the developmental requirements for greater independence in life cannot be fulfilled.

PANDEMIC AS A RISK FACTOR FOR STUDENTS’ MENTAL HEALTH PROBLEMS

The current pandemic can cause COVID19 [1, 20], a disease dangerous for many people but there are also many restrictions, e.g., quarantine, remote learning, recommendations on new ways of behaving, e.g., maintaining social distance, limiting the number of people at meetings, etc. These may cause serious stress or even a crisis for young people and trigger strong, often difficult, and inappropriate behaviours, as well as a broad range of mental health problems, including mental disorders and diseases [8, 10].

A crisis is characterised by its novelty, sudden onset, and the fact that previous ways of coping with stress are no longer effective or prove to be insufficient [20, 21]. The 2020-2022 pandemic situation meets all the above- mentioned criteria, namely:

Due to the pandemic situation (understood as a crisis situation), young people may develop mental health problems or have existing ones aggravated, which may have a significant impact on the study process. The most frequently observed mental health problems associated with the pandemic situation include anxiety disorders, depressive disorders, and psychotic disorders, violence (both aggressive behaviour and increased exposure to aggressive behaviour from others) as well as addictions [10, 22-24].

Anxiety disorders, including panic attacks, generalised anxiety syndromes, and obsessive-compulsive disorders, can occur for the first time in connection with pandemic stress, or they can significantly worsen, thus making daily functioning more difficult [10, 22, 24, 25]. The core symptom of these disorders is severe anxiety, which may manifest itself in different ways (see ICD-10). In the situation of a pandemic, which is potentially threatening to the health and life of an individual, anxiety occurs naturally and can make a person experiencing it more cautious and ready to follow the epidemiological recommendations issued by the authorities responsible for national security. The effect of severe anxiety may be difficulties in learning, remembering, and concentrating on the text being read. Some students find it very difficult or even impossible to study remotely and to use new technologies, e.g. communicating with lecturers and group mates via the Internet, videoconferencing, or using webcams. Sometimes this excludes them from participating in important academic activities and benefiting from them. Increased anxiety may result in avoiding contact with others, including that made via digital media (the author’s own observation), and thus deepen their loneliness and feelings of not being understood and not being able to cope [24, 25].

Depressive disorders are also common among students. There are observed decreased drive, vegetative disorders (changes in sleep, appetite) as well as suicidal thoughts and tendencies (see ICD-10). More and more scientific reports indicate that the pandemic situation increases the rate of the experience of anxiety, morbid thoughts and suicide attempts [10, 12, 24, 26-28]. The latter are associated with the uncertainty brought about by the pandemic. The need to change the lifestyle may, along with the restrictions imposed, also increase anxiety about the future, personal development and the possibility of self-determination. Young people suffering from depressive disorders may give up their studies because they are not able to actively participate in classes, do not see the point in continuing their education, or do not have the strength and energy for it. As a result of depressive disorders, students neglect not only their academic duties but also their physical health. They are not able to take care of their physical activity and diet, which objectively weakens their somatic health and immunity, which are so important when the body is attacked by viruses.

Psychosis is another disorder that can be associated with severe anxiety. Anxiety is exacerbated by inadequate coping methods. Anxiety can be redirected, for example, to the distance-learning system. Because of their delusions, students may become convinced that learning via the Internet is dangerous; they are afraid of being judged by others who can see them on camera, and so they give up on remote learning either gradually or right away. Sometimes they do not take it up at all. On the other hand, students suffering from psychosis could need to continue studying. It can be a very important factor in their empowerment and the process of recovery [29]. Adequate support seems to be crucial if they are to continue their academic activity.

Violence can result from intense frustration and failure to cope with stress. In a stressful pandemic situation, the intensity and frequency of various forms of aggression towards oneself and others (psychological and physical aggression) increases. The same goes for being a victim of violence [8]. An example of self-aggressive behaviour is addiction to psychoactive drugs. In a pandemic situation, the ability to move around, as well as many of one’s own initiatives, are significantly limited, which can result in increased frustration and reduced ability to effectively cope with stress, e.g. by doing sport. Also, the level of domestic violence and alcohol consumption increases [23, 24]. Both violence and addiction have a great impact on the physical, emotional, cognitive and social functioning of a person and may significantly limit their learning capacity and study opportunities, for example due to difficulties in concentration, lower levels of interest and cognitive curiosity, or weaker memory and physical performance. Strongly experienced emotions, with which an individual cannot cope effectively, limit his or her cognitive functioning and affect vegetative functions and immunity.

Mental health disorders can have a significant impact on, among other things, functioning at university or involvement in the studying process. They can hinder learning, passing examinations or even make it impossible to continue studying [10, 17, 25]. Lack of help and support for students with mental health problems may result in an increase in their difficulties, the exacerbation of disorders or the appearance of new ones, e.g. aggressive behaviour, addiction, etc.

PROPOSALS FOR STUDENT SUPPORT AT UNIVERSITIES DURING THE PANDEMIC

Mental health promotion, understood as its shaping and strengthening through the preparation and implementation of model mental health promotion programmes, has been recommended at universities in Poland and around the world for years [30-32]. Given the fact that the ongoing pandemic can be a source of severe stress and even lead to a crisis in students’ mental health, it is very important to monitor this, both among young people and in terms of the actions taken at university level to support students and prevent mental health disorders [33, 34]. The biggest universities in Poland and all over the word have been providing regular psychological support for their students in their own counselling centres or in cooperation with local public ones for many years. Unfortunately, not every university organizes this kind of support for its students [35]. In June 2021 The Ministry of Education and Science in Poland prepared some recommendations for university authorities to provide such psychological support (https://www.gov.pl/web/edukacja-i-nauka/pakiet-psychologiczny--rekomendacje-dla-uczelni-dotyczace-pomocy-studentom). This places the responsibility to take care of the students’ mental health with the university.

Below are presented some examples of support offered during the pandemic to students at the Maria Grzegorzewska University (APS) in Warsaw between March 2020 and December 2021, which can be an inspiration for the authorities of other higher education institutions to introduce equivalent measures. Three main activities which have been undertaken as a as a response to the pandemic as a potential crisis are described.

As part of the Academic Psychological Counselling Service (APP), which has been operating at the university since 2014 and which offers students free psychological support, counselling, crisis intervention, psychotherapy and mental health promotion workshops, the following activities have been carried out in cooperation with the university authorities, administration, and students:

1. Systematic publication of reliable information about the pandemic and ways of coping in a pandemic situation on the public website of the university and the counselling centre, and as posts on the Facebook page of the university and the Institute of Psycho- logy APS.

In a new and unfamiliar situation like that of a pandemic, anxiety and confusion can obviously arise. Moreover, misleading and chaotically presented information can cause additional difficulties, which nowadays is very common, given easy access to various data. It is extremely important to systematically inform students on how to stay safe, how to cope effectively, e.g. to study online, and where to get more psychological support and de- tailed information about the pandemic situation. This is an example of the support in the critical situation: information. If we treat the pandemic situation as a po- tential crisis it is important to provide support based on the idea of crisis intervention. In this psychological support information and providing a sense of security are crucial.

University media, e.g. the university website, Face-book page, etc. should be a source of reliable and upto-date information for students as well as guidance on how they should act and behave in a pandemic situation. Information about effective remote learning or online sessions may also prove helpful. At the same time, students themselves should be encouraged to contribute their ideas, publish their reflections and share them with the academic community. This is an example of the creative use of students’ potential. Furthermore, it provides students with empowerment and the motivation to find new solutions and effective ways of coping with the pandemic situation. At the Maria Grzegorzewska University website and Facebook page information was published every few weeks, especially during the strict lockdown, seasonal holidays (Easter, Christmas) and exam sessions.

2. Online psychological support. As soon as the uni- versity closed (12^th March 2020), the APP staff started providing psychological support via Teams, Skype and telephone.

In this way, those who previously received psychological support at the counselling centre could continue to be looked after by specialists. In turn, students who had not yet benefited from the assistance could electronically sign up for psychological consultations, crisis intervention, psychological counselling, and short-term psychotherapy. It is of the utmost importance to secure the continuity of psychological support and psychotherapy during the pandemic and the changed learning environment, on the one hand, and to be able to help those who are experiencing mental health problems due to the pan- demic situation on the other.

Depending on students’ preferences and abilities, counselling is offered by telephone or as videoconferencing. This is a recommended, safe, and easily accessible form of the provision of psychological support in the pandemic situation [19]. Twenty two hours of psychological support per week has been offered to students and staff of the university since March 2020. On average 20 students per week are consulted. It is worth stressing that students who are looking for psychological support are very motivated and almost always present themselves at the arranged psychological consultation. There are only about 0.05% of cancelled appointments by students (unpublished APP statistics report, 2020-2021). It is crucial that psychological support is available and for free in a crisis situation.

3. Relaxation workshops on the TEAMS platform.

Each week during the pandemic workshops were run on Tuesday evenings, at which different techniques for dealing with stress were presented, including Jacobson’s relaxation technique, Schultz’s autogenic training, and visualisation. The workshops were organised by the APP staff and psychology students at the APS Institute of Psychology, based on a mental health promotion programme previously implemented in on-campus meetings and appropriately evaluated [35]. The APS students and staff were invited to attend each workshop so that they could learn the theoretical basis of the presented technique and practice it during the workshop, as well as share their reflections. The workshops had the character of open online meetings. No one was obliged to speak if they did not want to. Those who felt like it could say something, make themselves visible to others by turning on their camera, or write a message in the chat room. The only framework for a meeting was time (the workshops always lasted 60 minutes) and enrolment for the team on the TEAMS platform via the APS mail, which guaranteed participation in the workshops only to members of the academic community. The workshops were always carried out on the TEAMS platform, which was recommended for use at the university, and therefore familiar to the APS students and staff, as this platform is used in the process of remote learning on a daily basis. Each meeting was led by students and a member of staff from the Institute of Psychology, which encouraged both students and staff to participate. All the practices mentioned above were deliberately applied in order to build a sense of security, community and mutual support, and at the same time leave space for individuality and decision-making for the people taking part in the workshops. Each workshop was attended by about 30 people. During the 2020-2021 period 290 people from the university community attended the workshops. Twenty students and staff were involved in organizing these for two years (unpublished APP statistics report, 2020-2021). All the workshop organizers worked as volunteers, so they were engaged in this activity if they had time and possibility to work. Information about the workshop was published a few days in advance on the Facebook page of the university and the APS Institute of Psychology. Positive feedback from the participants was collected as a preliminary to a comprehensive evaluation of the online activities, for future reference. The evaluation canon requires formative qualitative evaluation, i.e., questions about the personally experienced effects of the applied methods of work [35].

In the crisis situation a sense of security is crucial. Every week, systematic online meetings with peers and teachers who are members of the same academic community can have an important impact on one’s sense of security. First of all, there are systematic, repetitive and constant activities. There have been many changes in students’ live but there has still been the possibility to attend the workshops on every Tuesday. The second important thing was that during the workshops there have been opportunities to meet other members of the academic community and talk about one’s feelings or share one’s experience with reference to relaxation methods.

CONCLUSIONS

The university is an institution which educates a new generation and takes responsibility for its students’ state of knowledge. It should – in a broad promotional effort, which is considered to be especially important – also take responsibility for the mental health of its students and be a safe and stable place that supports students even in times of pandemics [36]. Thus, it does not just impart knowledge according to a field of study, but teaches young people how to live and how to cope. An example of a particular challenge is the sudden epidemic situation in 2020-2022, which is new and therefore requires novel solutions. Many universities in Poland provide support to their students and do so in accordance with the requirements of good practice [35]. It seems important to exchange experiences and share ideas and activities that strengthen students’ mental health.

The activities described have been provided for almost two years at The Maria Grzegorzewska University. Students are still interested in them and take part in these activities, e.g. in the workshops, and in online consultations. This seems to be evidence that all these actions should be continued and remain available to students. It is also very important that all the mental health promotion activities provided should be evaluated, for example by monitoring students’ mental health and assessing the quality of the information provided, workshops, and counselling via anonymous questionnaires [35]. The results of these evaluations will be published in the other article.

When treating the pandemic as a stressful situation, it is important to remember that it can trigger mental health crises or exacerbate already existing disorders. To counteract them, the following measures are recommended: