Psychological distress among university students during remote learning in Brazil: a multicenter online study

Barbosa, Bruna Carolina Rafael; Paula, Waléria de; Sales, Aline Dayrell Ferreira; Freitas, Eulilian Dias de; Chagas, Carolina Martins dos Santos; Oliveira, Helian Nunes de; Ferreira, Lívia Garcia; Silva, Luciana Saraiva da; Vidigal, Fernanda de Carvalho; Nobre, Luciana Neri; Machado, Elaine Leandro; Cardoso, Clareci Silva; Meireles, Adriana Lúcia

doi:10.1590/1516-3180.2024.0299.R1.07032025

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Sumário

ORIGINAL ARTICLE • Sao Paulo Med. J. 143 (5) • 2025 • https://doi.org/10.1590/1516-3180.2024.0299.R1.07032025 linkcopy

Psychological distress among university students during remote learning in Brazil: a multicenter online study

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND: Studies assessing the prevalence of mental disorders in the context of remote teaching in Brazil during the coronavirus disease (COVID-19) pandemic are scarce.

OBJECTIVE: To estimate the prevalence of symptoms of anxiety and depression and their relationship with sociodemographic characteristics among university students during the COVID-19 pandemic.

DESIGN AND SETTING: This multicenter cross-sectional study was conducted at eight Brazilian public universities.

METHODS: This study was conducted on students regularly enrolled in undergraduate courses. Data were collected between October 2021 and February 2022 using an online self-administered questionnaire that addressed sociodemographic and academic characteristics, lifestyle habits, and health conditions. Anxiety and depression symptoms were assessed using the Depression, Anxiety, and Stress Scale-21. The variables were analyzed descriptively using frequency distribution, proportion, 95% confidence interval (95% CI), and Pearson’s chi-squared test.

RESULTS: A total of 8,650 students participated, and most of them were women, white, heterosexual, cisgender, and unmarried, with a mean age of 23.9 (standard deviation: ± 6.34) years and living with family members. Symptoms of anxiety and depression were observed in 59.7% (95% CI: 58.7–60.7) and 63.0% (95% CI: 62.0–64.0) of the students, respectively. These symptoms were associated with sex, age, skin color, sexual orientation, gender identity, marital status, education of the head of the family, family income, decrease in income during the pandemic, and area of knowledge.

CONCLUSION: Most university students showed symptoms of anxiety and depression during the suspension of face-to-face activities in universities, indicating the need for institutional actions and public policies aimed at promoting their health and mental well-being.

KEYWORDS (MeSH terms):
COVID-19; Mental health; Students; Multicenter study

AUTHOR’S KEYWORDS:
Depression; Anxiety; Mental disorders; College students; Higher education

Modules	Variables	References
Student identification	Enrollment,* course, and institution.	Questions prepared by the project researchers.
General characteristics and socioeconomic conditions	Age, city of residence and housing, race, biological sex, gender identity, sexual orientation, level of education of the head of the family, marital status, family income, and religious belief.	Questions taken from and/or based on the Instituto Brasileiro de Geografia e Estatística¹² and Pesquisa Nacional de Saúde (PNS)¹³ census.
Life habits	Number of participants in remote teaching, difficulties in dealing with the pandemic, and study routine. Consumption of alcohol, tobacco, and illicit substances. Practice of physical exercise and sedentary behavior. Frequency and eating habits, self-efficacy for adopting healthy practices, emotional eating, body image issues, and dysfunctional eating attitudes.	Questions prepared by the project researchers. Questions taken from and/or based on the Instituto Brasileiro de Geografia e Estatística,¹² PNS,¹³ and Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL)¹⁴ census. Questions based on VIGITEL.¹⁴ Instrument constructed from items addressed in previous research with adolescents and young adults.¹⁵-²¹ The Three Dietary Factors Questionnaire was used to analyze the profile of eating behavior according to the emotional eating subscale score.²² The translated and validated version for the Brazilian population was used.²³ Simplified questionnaire of dysfunctional eating attitudes based on the study by Ferreira and Veiga (2008).²⁴
Health conditions	General health aspects, such as self-reported weight and height, presence of morbidities, self-rated health, suicidal ideation, and medication use.	Questions taken and/or adapted from the PNS,¹³ use of medication adapted from the study by Bertoldi et al.,²⁵ and study of self-injury adapted from Fonseca et al.²⁶
Anxiety, depression, and stress scale	Variables that assess symptoms of anxiety, depression, and stress.	Depression Anxiety Stress Scale-21, translated and validated by Vignola and Tucci.²⁷
Social support scale	Variables that assess social support.	Social support satisfaction scale, version adapted from Ribeiro²⁸ and Zanini et al.²⁹
Quality of life scale	Variables that assess quality of life.	Quality of life determines World Health Organization Quality of Life abbreviated version, translated and validated by Fleck et al.³⁰
Resilience scale	Variables that assess resilience.	Connor–Davidson Resilience Scale, translated and validated by Lopes and Martins.³¹

Variables		Total (n, %)	Anxiety symptoms		P value*	Depression symptoms		P value*
Variables		Total (n, %)	Normal and mild (n = 3,486)z	Moderate to extremely severe (n = 5,164)	P value*	Normal and mild (n = 3,201)	Moderate to extremely severe (n = 5,449)	P value*
Biological sex (n = 8,615)
	Male	2,955 (34.3)	1,560 (52.8)	1,395 (47.2)	< 0.001	1,234 (41.8)	1,234 (41.8)	< 0.001
	Female	566 (65.7)	1,913 (33.8)	3,747 (66.2)	< 0.001	1,959 (34.6)	1,959 (34.6)	< 0.001
Age
	18–20 years	2,552 (29.5)	969 (38)	1,583 (62)	< 0.001	977 (38.3)	1,575 (61.7)	0.006
	21–22 years	2,135 (24.7)	855 (40)	1,280 (60)		789 (37)	1,346 (63)
	23–25 years	2,000 (23.1)	759 (38)	1,241 (62)		677 (33.9)	1,323 (66.1)
	≥ 26 years	1,963 (22.7)	903 (46)	1,060 (54)		758 (38.6)	1,205 (61.4)
Skin color (n = 8,474)
	White	4,694 (55.4)	1,953 (41.6)	2,741 (58.4)	0.016	1,833 (39)	2,861 (61)	< 0.001
	Brown	2,622 (30.9)	1,047 (39.9)	1,575 (60.1)		961 (36.7)	1,661 (63.3)
	Black	1,039 (12.3)	382 (36.8)	657 (63.2)		307 (29.6)	732 (70.4)
	Yellow, Indigenous, and others	119 (1.4)	55 (46.2)	64 (53.8)		45 (37.8)	74 (62.2)
Sexual orientation (n = 8,374)
	Heterosexual	5,714 (68.2)	2,614 (45.8)	3,100 (54.2)	< 0.001	2,412 (42.2)	3,302 (57.8)	< 0.001
	Homosexual	753 (9)	254 (33.7)	499 (66.3)		217 (28.8)	536 (71.2)
	Bisexual	1,685 (20.1)	467 (27.7)	1,218 (72.3)		448 (26.6)	1,237 (73.4)
	Asexual and others	222 (2.7)	51 (23)	171 (77)		37 (16.7)	185 (83.3)
Gender identity (n = 8,433)
	Cisgender	8,211 (97.4)	3,353 (40.8)	4,858 (59.2)	< 0.001	3,075 (37.4)	5,136 (62.6)	< 0.001
	Transgender	59 (0.7)	17 (28.8)	42 (71.2)		24 (40.7)	35 (59.3)
	Non-binary	163 (1.9)	42 (25.8)	121 (74.2)		30 (18.4)	133 (81.6)
Marital status
	Single	7,775 (90.6)	3,067 (39.4)	4,708 (60.6)	< 0.001	2,819 (36.3)	4,956 (63.7)	< 0.001
	Married/stable union	709 (8.3)	356 (50.2)	353 (49.8)		321 (45.3)	388 (54.7)
	Widowed and divorced	98 (1.1)	42 (42.9)	56 (57.1)		44 (44.9)	54 (55.1)
Housing
	Without family members	2,048 (23.7)	2,697 (40.9)	3,905 (59.1)	0.061	2,467 (37.4)	4,135 (62.6)	0.211
	With family members	6,602 (76.3)	789 (38.5)	1,259 (61.5)	0.061	734 (35.8)	1,314 (64.2)	0.211
Education of the head of the family (n = 8,528)
	No education or incomplete primary education	1,297 (15.2)	429 (33.1)	868 (66.9)	< 0.001	405 (31.2)	892 (68.8)	< 0.001
	Complete primary education or incomplete secondary education	941 (11)	371 (39.4)	570 (60.6)		342 (36.3)	599 (63.7)
	Complete secondary education or incomplete higher education	2,931 (34.4)	1,171 (40)	1,760 (60)		1,035 (35.3)	1,896 (64.7)
	Complete higher education	3,359 (39.4)	1,463 (43.6)	1,896 (56.4)		1,381 (41.1)	1,978 (58.9)
Total family income**
	≤ 1–2 minimum wages	2,595 (32.1)	812 (31.3)	1,783 (68.7)	< 0.001	754 (29.1)	1,841 (70.9)	< 0.001
	3–5 minimum wages	3310 (40.9)	1,383 (41.8)	1,927 (58.2)		1,219 (36.8)	2,091 (63.2)
	6–10 minimum wages	1,397 (17.3)	642 (46)	755 (54)		603 (43.2)	794 (56.8)
	> 10 minimum wages	788 (9.7)	416 (52.8)	372 (47.2)		404 (51.3)	384 (48.7)
Drop in family income (n = 8,195)
	No	3,966 (48.4)	1,854 (46.8)	2,112 (53.2)	< 0.001	1,704 (43)	2,262 (57)	< 0.001
	Yes	4,229 (51.6)	1,463 (34.6)	2,766 (65.4)	< 0.001	1,332 (31.5)	2,897 (68.5)	< 0.001
Area of knowledge
	Exact Sciences	3,416 (39.5)	1,494 (43.7)	1,922 (56.3)	< 0.001	1,310 (38.3)	2,106 (61.7)	< 0.001
	Life Sciences	2,731 (31.6)	1,151 (42.1)	1,580 (57.9)		1,092 (40)	1,639 (60)
	Humanities and Social and Applied Sciences	2,503 (28.9)	841 (33.6)	1,662 (66.4)		799 (31.9)	1,704 (68.1)

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