Table of Contents
- Results from the Survey
- Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD
- Development and Initial Validation of the COVID Stress Scales
- Statistical Analysis
The effects of lockdown due to COVID-19 have been studied in several populations. Students in higher education institutions have experienced a complete overturn of student life routine. Face-to-face classes and seminars were discontinued, libraries and student residences(hostels) and restaurants were closed down, counselling services were provided sparsely and on-line only, student activities were cancelled, and students had to find a way to travel back to their homes. The new reality students had to adjust to, consisted of courses delivered as e-classes and on-line lectures, examinations (and assessments) that were mostly taken online.
The psychological impact of the COVID-19 epidemic on college students in China. Prior to the Covid-19 pandemic, studies conducted on Chinese university students found that public health emergencies induced anxiety, fear, and worry (Mei et al., 2011). The current crisis has resulted in a variety of reports on the psychological impact of the epidemic on the general public, patients, medical staff, children, and older adults (Q. Chen et al., 2020; Yang et al., 2020; Li et al., 2020).
However, until September and October 2020, no detailed studies had been published on the effect of the Covid-19 pandemic on the mental and emotional status of university students. nd mental health status of college students facing this epidemic has been conducted to date. A Chinese survey of this demographic indicated that 24.9% of college students experienced anxiety because of the COVID-19 outbreak (Cau, et al., 2020).
Interestingly, and particularly relevant to the South African milieu, it was found that students from urban areas, in contrast were less anxious than their counterparts from rural areas, this might be explained by the imbalance of economic, cultural, and educational resources between urban and rural areas. Also, access to social support was negatively correlated with the anxiety of college students, which is consistent with previous findings (Thompson et al., 2016; Q. Chen et al., 2020).
In support of the findings of studies conducted on university students in Greece and China, research, 1512 Ukrainian students were administered these questionnaires and the results showed them to be at significantly higher risk of experiencing anxiety and depression than other populations, resulting from this pandemic’s lockdown period. Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic?
Some studies have been conducted on students undertaking Health Sciences/Medical Sciences-related courses in the context of the Covid-19 pandemic. Academic stress was higher for students who were studying ‘Engineering, Manufacture and Construction’ when compared with the stress of students in other study areas. The lowest stress levels were observed among ‘Health and Welfare’ students. STUDENT WELL-BEING DURING THE COVID-19 PANDEMIC IN GREECE.
Results from the Survey
The effect of lockdown on university students has thus been studied during the current pandemic, although not exhaustively. The impact of the pandemic’s lockdown on students with ADHD has not been investigated, although one study was conducted on a group of non-students diagnosed with ADHD.
The effects of lockdown on an adult, non-student ADHD population were recorded. The individuals surveyed had a mean age of 21 years and 9 months comprising 18 males and 8 females. Despite these subjects recording significant levels of emotional distress during the COVID-19 lockdown period, there was no evidence of significant deterioration of their mental health, if they maintained their medication regimen (CONTRARY/UNEXPECTED FINDING).
The term ‘special educational needs’ can refer to learning difficulties ranging from emotional, behavioural or physical challenges that inhibit, amongst other challenges, a person’s ability to learn and socialise. In the case of persons with Attention Deficit Hyperactivity Disorder (ADHD), the barriers to effective academic learning in Higher Education Istitutes(HEIs) can be lowered by treatment regimens involving medication and where indicated, psychological support. ADHD students require significant input from educators and in-person accountability such as meeting regularly to discuss progress contributes to the keeping of ADHD students ‘on task’ by, among other mechanisms, the setting of smaller achievable goals.
Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD
A longitudinal study in Pittsburgh showed that educational and occupational attainment was lower for adults with ADHD compared to adults without histories of childhood ADHD. Despite this poor outcome, there is evidence that a sub-group of children diagnosed with ADHD are successful after high school. A review by Hechtman (1999) found that 30 % of adults with childhood ADHD functioned as well as their non-AHD counterparts and that they graduated from HEIs and achieved high status employment.
All but one of the studies referenced in this proposal have made use of the Generalized Anxiety Disorder (GAD-7) scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic? The GAD-7 takes less than 3 min to complete and is easy to score (Budikayanti et al., 2019). The 7-item Generalized Anxiety Disorder Scale (GAD-7) is one of the most widely used instruments for the detection and screening of anxiety disorders, and it is a module of the ‘Patient Health Questionnaire (PHQ; Spitzer et al., 1999),
Development and Initial Validation of the COVID Stress Scales
Aside from these widely used instruments, a 36-item COVID Stress Scale (CSS) has been developed to measure stressors related to COVID-19. The CSS were developed specifically, better to understand and assess COVID-19-related distress. A sample of 3375 participants generated a stable, 5-factor solution corresponding to scales assessing COVID-related stress and anxiety symptoms. These were: (1) Danger and contamination fears, (2) fears about economic consequences, (3) xenophobia, (4) compulsive checking and reassurance seeking, and (5) traumatic stress symptoms about COVID-19. The scales performed well on various indices of reliability and validity.
A separate assessment of the COVISTRESS Questionnaire was conducted on participants from ‘executive and superior intellectual occupations’, including students of medicine, pharmacy and dentistry. This questionnaire revealed elevated psychological distress, anxiety, depression, and worry about family and friends contracting Covid-18.
The target respondent group consists of male and female students in every School in the Health Sciences faculty of the University of the Witwatersrand. Age and ethnicity are deliberately excluded from the selection criteria due to the already small sample size of students diagnosed with ADHD. Within the target group, the primary discriminant variable distinguishes two major groups; Students clinically diagnosed with ADHD and a non-ADHD control group. Students with a history of ADHD, but who no longer manifest treatable symptoms according to ICD-10 classification, are moved into the control group.
Students will be administered a modified questionnaire based on the GAD-7, PHQ-9 and CoviStress scales. The objective of this study is to establish the extent to which ADHD exacerbates the effects of stressors consequent to the Covid-19 pandemic and lockdown. The nature of the questions aims to elucidate conditions experienced by South African health sciences students in general, and specifically students with ADHD.
These stressors are related to uniquely South African conditions such as the urban-rural divide, access to the internet and study materials, food insecurity consequent to decreased family income from job losses, inaccessibility to psychosocial support provided by the University, social isolation and overcrowded housing conditions.
The GAD-7 and PHQ-9 will be analysed by assigning a coded value of 1 through 4 to each of the response categories. These values are then tallied to generate a composite score, which is compared against the cut-off scores for anxiety and depression as seen in Figure 1. A t-test will be used to determine if a correlation exists between ADHD and exacerbated symptoms of anxiety and depression.
There are 5 discrete response options that participants can choose from for each question of the modified Covistress survey. The total number of responses to each of the 5 options provided per question will be tallied and recorded. This ordinal data will be subjected to a Mann-Whitney rank-sum test to compare responses of both groups to each question so that a determination can be made, whether or not ADHD exacerbates the severity of Covid-19 related stressors.
An application to the Human Reasearch Ethics Committee will be submitted. No personal information will be collected. Invitations, with a link to the survey will be sent to all students in the HS faculty and their responses to the questionnaire will be anonymous. E-mail addresses will be provided by the HS Faculty office, with no possibility of their being linked to the individuals who complete the survey.
There is no need for funding this research. There are no stationary or printing costs associated with the questionairres. The computer equipment and facilities provided by the university are essentially funded through fees paid by the student investigator. Any ad hoc expenses such as commissioning an external statistition will be borne by the investigator.
Unlike the GAD-7 and PHQ-9, the CoviStress Scale (CSS) does not incorporate diagnostic criteria found in the Diagnostic and Statistical Manual V (DSM-5) or the International Classification of Diseases(ICD-11). It is expected that scores would be higher from those with pre-existing anxiety-related conditions, such as generalized anxiety disorder, and Obsessive Compulsive Disorder regardless of ADHD diagnosis.
The study should be expanded to Health Sciences faculties across the country as the ADHD group is likely to be much smaller than the control group, leading to results being skewed in favour of the much larger non-ADHD control group.
This study relies on an online survey method of evaluation and self reporting of the measurement scale. Development and initial validation of the COVID Stress Scales. To reduce the incidence of the submission of multiple questionaries, IP addresses would be captured and examined for duplicate submissions, It is still possible, but unlikely that the same participant would submit several questionnaires from diﬀerent IP addresses.
In conclusion, COVID-19 and the advent of mass remote learning has changed the Higher Education landscape for the foreseeable future. Broadly, initial results support the potential for remote learning to produce similar outcomes in terms of satisfaction and assessment results, during the global pandemic. Results may differ over longer time-periods, across nations with different equity profiles, with less synchronous learning, and potentially in semester rather than block mode. The current data does not capture many elements of University education that may potentially differ online, and a phased return to on-campus education is desirable when safe.
- Asbury, K. et al., 2020. How is COVID-19 Affecting the Mental Health of Children with Special Educational Needs and Disabilities and Their Families?. J Autism Dev Discord.
- Burgess, S. & Sievertsen, S., 2020. Schools, skills, and learning: The impact of COVID-19 on education. [Online]
- Available at: https://voxeu.org/article/impact-covid-19-education
- Cau, W. et al., 2020. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, Volume 287, p. 112934.
- Chandu, V. C. et al., 2020. Measuring the Impact of COVID-19 on Mental Health: A Scoping Review of the Existing Scales. Indian Journal of Psychological Medicine, 45(5), pp. 421-427.
- Duraku, Z. & Nagavci, M., 2020. The impact of the COVID-19 pandemic on the education of children with disabilities.
- Elumalai, K. et al., 2020. Factors affecting the quality of e-learning during the COVID-19 pandemic from the perspective of higher education students. Journal of Information Technology Education: Research, Volume 19, pp. 731-753.
- Gonzalez, C. et al., 2020. COVID-19 voluntary social isolation and its effects in sociofamily and children's behavior. Salud Mental, 43(6), pp. 249-257.
- Loton, D., Parker, P., Stein, C. & Gauci, S., 2020. Remote learning during COVID-19: Student satisfaction and performance.
- Nambiar, D., 2020. The impact of online learning during COVID-19: students' and teachers' perspective. The Internation Journal of Indian Psychology, 8(2), pp. 783-793.
- Nikcevic, A. & Spada, M., 2020. The COVID-19 anxiety syndrome scale: Development and psychometric properties. Psychiatry Research, Volume 292, p. 113322.
- Rogowska, A. et al., 2020. Does Physical Activity Matter for the Mental Health of University Students during the COVID-19 Pandemic?. J Clin Med, 9(11), p. 3494.
- Saraswathi, I. et al., 2020. Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study. PeerJ, Volume 8.
- Stathopoulou, T., Mouriki, A. & Papaliou, O., 2020. Student well-being during the COVID-19 pandemic in Greece. Results from the C-19 ISWS Survey, s.l.: s.n.
- Taylor, S. et al., 2020. Development and initial validation of the COVID Stress Scales. Journal of Anxiety Disorders, Volume 72.
- Ugbolue, U. C. et al., 2020. An Assessment of the Novel COVISTRESS Questionnaire: COVID-19 Impact on Physical Activity, Sedentary Action and Psychological Emotion. J Clin Med, Volume 9, p. 3352.