Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students

Abstract

Background: The COVID-19 pandemic has negatively affected the mental health of university students.

Objective: This study examined the psychological responses toward COVID-19 among university students from 3 countries-Indonesia, Taiwan, and Thailand.

Methods: We used a web-based, cross-sectional survey to recruit 1985 university students from 5 public universities (2 in Indonesia, 1 in Thailand, and 1 in Taiwan) via popular social media platforms such as Facebook, LINE, WhatsApp, and broadcast. All students (n=938 in Indonesia, n=734 in Thailand, and n=313 in Taiwan) answered questions concerning their anxiety, suicidal thoughts (or sadness), confidence in pandemic control, risk perception of susceptibility to infection, perceived support, resources for fighting infection, and sources of information in the context of the COVID-19 pandemic.

Results: Among the 3 student groups, Thai students had the highest levels of anxiety but the lowest levels of confidence in pandemic control and available resources for fighting COVID-19. Factors associated with higher anxiety differed across countries. Less perceived satisfactory support was associated with more suicidal thoughts among Indonesian students. On the other hand, Taiwanese students were more negatively affected by information gathered from the internet and from medical staff than were Indonesian or Thai students.

Conclusions: Our findings suggest that health care providers in Thailand may need to pay special attention to Thai university students given that high levels of anxiety were observed in this study population. In addition, health care providers should establish a good support system for university students, as the results of this study indicate a negative association between support and suicidal thoughts.

Keywords: COVID-19; anxiety; cross-country; suicidal thoughts; university students.

Figure 1

Results of the proposed model showing standardized coefficients among Indonesian, Taiwanese, and Thai students. *P<.05, **P<.01, ***P<.001. Gender was controlled for in the model. Suicidal thoughts were assessed for Taiwanese and Indonesian students; sadness was assessed for Thai students. Confidence was constructed using (1) confidence to deal with the pandemic, (2) confidence of the city to deal with the pandemic, and (3) confidence of students to deal with the pandemic. Risk perception was constructed using (1) perceived absolute susceptibility to COVID-19 and (2) perceived relative susceptibility to COVID-19. Support was constructed using (1) satisfaction with family support, (2) satisfaction with friend support, and (3) satisfaction with university support. Resource was constructed using (1) sufficiency of personal protective equipment, (2) sufficiency of information, (3) sufficiency of money, (4) sufficiency of medical resources, and (5) sufficiency of psychological support. Fit indices: χ2378=1035.12; P<.001; comparative fit index=0.92; Tucker-Lewis index=0.90; root mean square error of approximation=0.051 (90% CI 0.048-0.055); standardized root mean square residual index=0.053.