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. 2021 Nov;49(7):741-749.
doi: 10.1177/14034948211015814. Epub 2021 May 26.

Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study

Fred Johansson  1   2 , Pierre Côté  3 , Sheilah Hogg-Johnson  3   4 , Ann Rudman  5   6 , Lena W Holm  2 , Margreth Grotle  7   8 , Irene Jensen  2 , Tobias Sundberg  1   2 , Klara Edlund  1   2 , Eva Skillgate  1   2
Affiliations

Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study

Fred Johansson et al. Scand J Public Health. 2021 Nov.

Abstract

Aims: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems.

Methods: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications.

Results: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to 0.45) at FU1 and decreased by 0.75/21 (95% CI:-0.97 to -0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: -0.24 to 0.07) and by 0.77/21 (95% CI: -0.93 to -0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: -0.52 to -0.09) and by 1.32/21 (95% CI: -1.55 to -1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms.

Conclusions: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects.

Keywords: COVID-19; Depression; Sweden; anxiety; coronavirus; mental health; stress; students.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of inclusion of participants.
Figure 2.
Figure 2.
Mean scores on the depression, anxiety and stress scale (DASS-21) subscales over the three time periods.
Figure 3.
Figure 3.
Estimated mean of depression, anxiety and stress scale (DASS-21) scores over time stratified by loneliness, sleep quality and pre-pandemic mental health (MH) problems. Adjusted for gender and age. BL, baseline.
See this image and copyright information in PMC

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