Skip to main content
NCBI home page
SAGE Open Nursing logoLink to SAGE Open Nursing
. 2023 Dec 18;9:23779608231220514. doi: 10.1177/23779608231220514

Psychological Effect of the COVID-19 Pandemic on Nursing Students: Palestinian Perspective

Farid Abu Liel 1,✉
PMCID: PMC10734324  PMID: 38130470

Abstract

Introduction

COVID-19 has had an important effect on nursing students, with some having their clinical practice cancelled or suspended and others suffering from the virus.

Objective

The purpose of this study was to assess the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic.

Methods

The study was cross-sectional, carried out by a convenience sample of 320 participants of nursing students between May and June 2020. Data collection was performed by “Depression Anxiety Stress-21 Scale” (DASS-21).

Results

The results revealed that 78 (24.3%) of participants reported stress; 121 (37.8%) reported anxiety; and 72 (22.5%) reported depression. Also, grade and socioeconomic status had statistically significant effect on anxiety, stress, and depression. In addition, age had statistically significant effect on depression, place of residence had statistically significant effect on anxiety, and gender had statistically significant effect on stress.

Conclusion

The study confirmed an alarming number of nursing students who experienced anxiety, stress, and depression. This study serves as an evidence concerning nursing students’ mental health issues as a consequence of the COVID-19 pandemic.

Keywords: students, nursing, anxiety, stress, depression

Introduction

The world's economy, politics, health, and education have all been put at risk by COVID-19 (Huang et al., 2022; Kar et al., 2023; Khankeh et al., 2022; Kukreti et al., 2023; Liu et al., 2022; Prasiska et al., 2022). University students from several countries have been significantly impacted by the epidemic; according to UNESCO, 60% of students worldwide have been placed under national lockdowns (Patelarou et al., 2021). This has forced the transition to a virtual teaching approach and the suspension of vital educational activities. The academic health science community consequently had a significant impact, with clinical practices interrupted mostly as a result of transmission anxiety and illness uncertainty (Reverté-Villarroya et al., 2021). The anxiety, stress, and depression levels of students were directly impacted by this situation. According to Marcén-Román et al. (2021), social interaction predicts clinically severe social anxiety, stress, and depression.

Nursing students have been significantly impacted by COVID-19, with some seeing their clinical rotations canceled or halted and others contracting the virus (Patelarou et al., 2021; Ulenaers et al., 2021). Many fourth-year nursing students decide to work in healthcare settings for moral and professional reasons, putting their health in danger while doing so (Roca et al., 2021). Additionally, employment pressure and uncertainty related to the pandemic affected nursing students who were prepared to graduate and become professional nurses, which caused them to experience psychological distress (Ayed et al., 2021; Zhu et al., 2021).

Nursing students should always be seen as a high-risk population that might experience psychopathology as a result of the pandemic. It is generally known that academic life has a negative impact on mental health and that the commencement of university studies is a critical time period for the onset of mental illness. Additionally, it has been shown that students pursuing health-related degrees, such as nursing, are more likely to experience this predicament (Reverté-Villarroya et al., 2021). They must complete several academic tasks, in-depth theoretical coursework, and clinical practice, all of which may add to their psychological burden (Cheung et al., 2016).

Technical and theoretical components are common in nursing bachelor's programs. Because clinical experiences are an essential component of technical progress, second-year nursing students at various Palestinian institutions undergo their first training in hospitals. For instance, at the Arab American University, nursing students have approximately half the credits representing mandatory clinical practice, where six credits must be completed during the first semester of the second year.

Literature Review

Numerous studies have revealed that the last year of university and the time preceding clinical practice make healthcare students more apprehensive (Ahorsu et al., 2021; Pramukti et al., 2020; Toqan et al., 2023). Many students find that going to class at school helps them manage and maintain social connections. Unfortunately, now that formal lectures have been stopped, students are at risk of loneliness and a lack of contacts (Reverté-Villarroya et al., 2021). Students during the COVID crisis were twice as likely to have mental health issues, according to research that analyzed mental health issues among nursing students in 2017 before COVID-19 and in 2020 during the pandemic in Spain (Reverté-Villarroya et al., 2021). A survey done in Turkey during the pandemic also revealed that 71.5% of nursing students were prone to developing mental illness.

Anxiety, stress, and depression are the three mental illnesses that university students experience most frequently (Cheung et al., 2016). Additionally, the COVID-19 pandemic had created a climate of anxiety, fear, and uncertainty (Yıldırım et al., 2021).

One year after the pandemic, a study in Spain that examined stress among health students discovered that 71.4% and 81.8% of them had anxiety and depression, respectively. This finding suggests that work status was a greater risk factor because 81.8% of those who did not work had stress (Marcén-Román et al., 2021). However, a study of Chinese nursing students during the COVID-19 epidemic found that there was a 55.0% anxiety rate, a 56.4% depression rate, and a 31.6% comorbid anxiety and depression rate. Poor family function has been associated with comorbid anxiety and depression, self-esteem difficulties, social anxiety, and bad moods (Zhu et al., 2021).

Additionally, Spanish students (59.1%) were more depressed than Greek students (21.8%) and Albanian students (34.5%) in a COVID-19 comparative study of depression among nursing students, pointing out that demographics are a strong predictor of depression, which may be related to heightened public anxiety caused by the rise in mortality in the area (Patelarou et al., 2021).

Numerous studies were carried out to determine the psychological impact of COVID-19 on various populations, including the general public, the health care profession, university staff, university students, and the elderly (Alimoradi et al., 2022; Aljaberi et al., 2023; Chen et al., 2020; Lin et al., 2022; Meng et al., 2020; Nayan et al., 2022; Sangma et al., 2022; Shouli et al., 2022; Tsai et al., 2023; Vicerra, 2022; Wang et al., 2020).

The Current Study

Palestine has a dense population, a high unemployment rate, particularly among young people, and stagnating economic and academic environments (Albarqouni et al., 2018). The situation aggregated with COVID-19 and its consequences. There are lack of studies on psychological effect of COVID-19 on nursing students in Palestine. As a result, the goal of this study was to assess the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic.

Methods

Design and Setting

A cross-sectional study was conducted between May and June 2020 at Arab American University. Arab American University is the largest nursing school in Palestine, with a student body of 1,500 bachelor and graduate nursing students. The bachelor program is four years obtaining a baccalaureate in nursing.

Research Question

What is the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic?

Population and Sample

Raosoft software was used to compute the sample size, which kept the population size at 1,500 and the response distribution at 50%, while the confidence interval and margin of error were fixed at 95% and 5%, respectively. The sample size calculated was 306. The study enrolled a convenient sample of 320 participants from the Baccalaureate Nursing Program.

Inclusion and Exclusion Criteria

All bachelor's nursing students and those without illnesses that would prohibit them from finishing the study were eligible. Students in the first year were excluded since they had not yet enrolled in the nursing program's practical component.

Instruments

The questionnaire was divided into three parts, the first of which includes demographic information including age, gender, grade, place of residence, and economic status. The second part asked students to answer two yes-or-no questions about their health and COVID-19 characteristics, including if they had a chronic disease or a COVID-19-diagnosed relative. The “Depression Anxiety Stress-21 Scale” (DASS-21), developed by Lovibond and Lovibond (1995), formed the third part. There are 21 items total, each evaluated on a “4-point Likert scale.” The DASS-21 total scores are divided into four categories: normal (0–7), mild (8–9), moderate (10–14), severe (15–19), and very severe (20+) for the anxiety subscale; normal (0–14), mild (15–18), moderate (19–25), severe (26–33), and extremely severe (34+) for the stress subscale; and normal (0–9), mild (10–13), moderate (14–20), severe (21–27), and extremely severe (28+) for the depression subscale.” The “DASS-21” has shown good psychometric properties globally in different languages (Cao et al., 2023a, 2023b; Chen et al., 2023).

Data Collection

Nursing students were recruited to participate in the study once the researcher received approval to carry it out. Upon meeting the vice dean of the nursing school, the researcher requested that he act as a liaison for approaching nursing program students. The vice dean's duties were restricted to addressing students, explaining the study's goals and methodology, and extending an invitation for them to participate. The researcher was then invited by the vice dean to provide students who indicated a willingness to participate with related study information. The aims of the study were then discussed with the nursing students by the researcher. The students completed the paper-based questionnaire in English language after signing the informed consent form. Participants put on masks while answering the surveys for pandemic control.

Data Analysis

Data was statistically analyzed using SPSS version 23. Data were provided as a percentage and frequency using descriptive analysis. The χ2 was used to assess the differences between the variables.

Ethical Considerations

It was ethically approved by the Arab American University. The possibility of leaving the study at any moment was made known to the students. An informed consent form was assigned by students who agreed to participate in the study. Students were verbally reassured that participating in the study was optional and would not have any impact on their academic experience.

Results

Participants’ Characteristics

Three hundred and twenty nursing students out of 336 participated in the study. The findings revealed that approximately 270 (84.4%) of students’ age were 20–25 years old and 191(59.7%) were males. Also, more than one-third of them 119 (37.2%) were in third year and 180 (56.3%) live in a village or town. Most of the participants 214 (66.9%) reported that their socioeconomic status were bad, as shown in Table 1.

Table 1.

Demographic Characteristics of the Participants (N = 320).

Variable N (%)
Age/year <20 39 (12.2)
20–25 270 (84.4)
>25 11 (3.4)
Gender Male 191 (59.7)
Female 129 (40.3)
Grade Second year 100 (31.3)
Third year 119 (37.2)
Fourth year 101 (31.6)
Place of residence City 86 (26.9)
Village or town 180 (56.3)
Camp 54(16.9)
Socioeconomic status Good 29 (9.1)
Average 77 (24.1)
Bad 214 (66.9)
Open in a new tab

Also, the analysis revealed that 299 (93.4%) of the participants had no chronic diseases and 217 (67.8%) had no any relative diagnosed with COVID-19, as shown in Table 2.

Table 2.

Students’ Health and COVID-19 Characteristics (N = 320).

Variable N (%)
Presence of a chronic disease Yes 21 (6.6)
No 299 (93.4)
COVID-19 diagnosed relative Yes 103 (32.2)
No 217 (67.8)
Open in a new tab

Research Question Results

According to mental health of nursing students, the analysis revealed that 78 (24.3%) of participants reported stress; 121 (37.8%) reported anxiety; and 72 (22.5%) reported depression symptoms, as shown in Table 3.

Table 3.

Characteristics of Mental Health of Nursing Students (N = 320).

Stress Anxiety Depression
Level N (%) N (%) N (%)
Normal 242 (75.6) 199 (62.2) 248 (77.5)
Mild 26 (8.1) 26 (8.1) 25 (7.8)
Moderate 24 (7.5) 53 (16.6) 26 (8.1)
Severe 16 (5.0) 20 (6.3) 11 (3.4)
Extremely severe 12 (3.8) 22 (6.9) 10 (3.1)
Total 78 (24.3) 121 (37.8) 72 (22.5)
Open in a new tab

The χ2 analysis revealed that grade and socioeconomic status had statistically significant effect on anxiety, stress, and depression (p < .05). Also, age had statistically significant effect on depression (p < .05), place of residence had statistically significant effect on anxiety (p < .05), and gender had statistically significant effect on stress (p < .05), as shown in Table 4.

Table 4.

Differences Between Nursing Students Socio-Demographic and Mental Health.

Stress Anxiety Depression
Variable N (%) χ2 p-value χ2 p-value χ2 p-value
Age/year <20 39 (12.2) 42.2 .375 10.1 .261 20.1 .010*
20–25 270 (84.4)
>25 11 (3.4)
Gender Male 191 (59.7) 11.9 .018 1.5 .836 4.1 .395
Female 129 (40.3)
Grade Second year 100 (31.3) 31.4 .001 68.1 .001 32.5 .001*
Third year 119 (37.2)
Fourth year 101 (31.6)
Place of residence City 86 (26.9) 13.3 .102 17.5 .025 9.2 .329
Village or town 180 (56.3)
Camp 54 (16.9)
Socioeconomic status Good 29 (9.1) 31.2 .001 74.8 .001 26.2 .001*
Average 77 (24.1)
Bad 214 (66.9)
Open in a new tab
*

Significant at the .05 level.

Discussion

The present study assessed the psychological status in terms of stress, anxiety, and depression of nursing students during COVID-19 pandemic. The current study, which used the DASS-21, revealed that 22.2% of nursing students had stress, 36.1% had anxiety, and 23.1% had depression. This outcome was consistent with a number of earlier investigations. According to research by Hai et al. (2022), stress, anxiety, and depression were present in 22.2%, 36.1%, and 23.1% of nursing students, respectively.

The current findings, however, were higher than those of earlier investigations. The prevalence of anxiety, stress, and depression was found to be 4.5%, 10.1%, and 8.3%, respectively, in nursing students at Bach Mai Medical College (Điệp et al., 2021). According to Kính (2017), depression, stress, and anxiety were present in 10.42%, 26.0%, and 20.8% of nursing students at Tien Giang Medical College, respectively.

The literature indicated that because of their well-informed choices, nursing students already experience high levels of stress (Ayed, 2022; Toqan et al., 2022). These students’ anxiety levels might rise if pandemic hazards are included (Kuru Alici & Ozturk Copur, 2021). According to a Japanese study, nursing students were more impacted by COVID-19-related anxiety than nurses were (Hasuike et al., 2021). This could be attributed to the financial instability, infection fear, social isolation, and uncertainty about the future of their academic careers that nursing students encountered during the pandemic (Sultana et al., 2021).

Therefore, the current findings are plausible in light of the COVID-19 pandemic, and WHO has stated that implementing measures like social isolation may cause people to feel stressed, anxious, or angry (WHO, 2020). According to Matthews et al. (2019), social isolation has been associated with sadness, anxiety, self-harm, and suicidal thoughts. In addition to the fundamental elements mentioned above, clinical training interruption may be a significant aspect of mental health.

The problems that nursing students face with stress, anxiety, and depression differ by nation. In a study on Turkish nursing students’ mental health done in 2021, it was found that 38.2% of them had stress, 58.8% had anxiety, and 56.3 had depression (Dastan et al., 2021). Rasmussen and colleagues further examined the mental health of Australian nursing students in 2021, finding that 63.8% had depression, 52.7% had anxiety, and 55.1% had stress (Rasmussen et al., 2022). The previous studies indicated greater results than the ones seen in the current study. The period of time during the epidemic when the data collection was done can be used to explain this disparity.

However, compared to the Juan Gao study, which was onducted in China in April 2020 (Gao et al., 2021), there were more nursing students in this study who reported feeling stressed, anxious, or depressed. Even though the DASS-21 scales were utilized in all of the previous studies, differences in the COVID-19 epidemic's state, national culture, student lifestyle, educational program characteristics, and other factors led to disparities in mental health levels.

The results of the present study showed that socioeconomic status and grade had a statistically significant impact on stress, anxiety, and depression. Also, age had a statistically substantial effect on depression, place of residence had a statistically significant effect on anxiety, and gender had a statistically significant effect on stress. According to a study by Cao and his colleagues published in 2020, families’ steady income is thought to be a defense mechanism against the symptoms of anxiety. Low socioeconomic status may also be linked to increased viral infection risk and inadequate preventive and treatment options, leading to considerably worse illness outcomes. Students with higher monthly expenses had more psychological stress, according to a study by Zhi et al. (2022) in China among nursing students. Similar earlier research suggested that men and women had different levels of stress (Wang et al., 2020). Additionally, there was no difference between men and women in terms of anxiety (Huang & Zhao, 2020; Nemati et al., 2020) or depression (Shevlin et al., 2020).

Strengths and Limitations of the Study

Study limitations were identified, including the cross-sectional design and self-reported measurements. A cross-sectional approach did not investigate the causal-effect relationship between variables, and self-reported questionnaires have the challenge of subjectivity. Therefore, it is necessary for future longitudinal studies to be conducted. The study was conducted in one university and this may limit the generalizability of the study.

Implications for Practice

During remote learning, it is critical to evaluate the effect of the COVID-19 pandemic on nursing students’ mental health. Furthermore, it is critical to give psychological support and counseling to nursing students in order for them to be able to overcome problems caused by pandemics.

Conclusion

The results of this study on nursing students’ mental health indicated that a concerning percentage of them experienced anxiety, stress, and depression. According to the results of the current study, anxiety, stress, and depression were statistically significantly influenced by grade and socioeconomic status. Also, the COVID-19 pandemic has been responsible for mental health issues in nursing students. As a result, families and society should take this issue seriously and emphasize putting effective strategies in place to reduce anxiety, stress, and depression in nursing students, who are crucial to advancing the general public's health. Universities in particular should consider focused, approachable strategies for supporting student mental health, such as details about on-campus mental health resources and integrated student mental health services. These findings recommend that universities and nursing schools investigate the creation of effective social networks, such as psychological counseling websites or hotlines, to help nursing students cope with complex situations and prevent mental health problems.

Acknowledgments

The authors would like to express their thanks to the nursing students who participated in the study.

Footnotes

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: Farid Abu Liel https://orcid.org/0000-0002-4193-4091

References

  1. Ahorsu D. K., Pramukti I., Strong C., Wang H. W., Griffiths M. D., Lin C. Y., Ko N. Y. (2021). COVID-19-related variables and its association with anxiety and suicidal ideation: Differences between international and local university students in Taiwan. Psychology Research and Behavior Management, 15(14), 1857–1866. 10.2147/PRBM.S333226 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Albarqouni L., Elessi K., Abu-Rmeileh N. M. (2018). A comparison between health research output and burden of disease in Arab countries: Evidence from Palestine. Health Research Policy and Systems, 16(1), 25. 10.1186/s12961-018-0302-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Alimoradi Z., Ohayon M. M., Griffiths M. D., Lin C. Y., Pakpour A. H. (2022). Fear of COVID-19 and its association with mental health-related factors: Systematic review and meta-analysis. BJPsych Open, 8(2), e73. 10.1192/bjo.2022.26 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Aljaberi M. A., Al-Sharafi M. A., Uzir M. U. H., Sabah A., Ali A. M., Lee K. H., Alsalahi A., Noman S., Lin C. Y. (2023). Psychological Toll of the COVID-19 Pandemic: An in-depth exploration of anxiety, depression, and insomnia and the influence of quarantine measures on daily life. Healthcare, 11(17), 2418. MDPI AG. 10.3390/healthcare11172418 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ayed A. (2022). Effect of progressive muscle relaxation exercise on anxiety among nursing students before psychiatric and mental clinical training. Journal of the Arab American University, 8(2), 1–12. [Google Scholar]
  6. Ayed A., Malak M. Z., Al-amer R. M., Batran A., Salameh B. (2021). Effect of high fidelity simulation on perceptions of self-awareness, empathy, and patient-centered care among university pediatric nursing classes. Clinical Simulation in Nursing, 56, 84–90. 10.1016/j.ecns.2021.04.005 [DOI] [Google Scholar]
  7. Cao C. H., Liao X. L., Gamble J. H., Li L. L., Jiang X. Y., Li X. D., Griffiths M. D., Chen I. H., Lin C. Y. (2023a). Evaluating the psychometric properties of the Chinese depression anxiety stress scale for youth (DASS-Y) and DASS-21. Child and Adolescent Psychiatry and Mental Health, 17(1), 106. 10.1186/s13034-023-00655-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cao C. H., Liao X. L., Jiang X. Y., Li X. D., Chen I. H., Lin C. Y. (2023b). Psychometric evaluation of the depression, anxiety, and stress scale-21 (DASS-21) among Chinese primary and middle school teachers. BMC Psychology, 11(1), 209. 10.1186/s40359-023-01242-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Chen I.-H., Chen C.-Y., Laio X.-L., Chen X.-M., Zheng X., Tsai Y.-C., Lin C.-Y., Griffiths M. D., Pakpour A. H. (2023). Psychometric properties of the depression, anxiety, and stress scale (DASS-21) among different Chinese populations: A cross-sectional and longitudinal analysis. Acta Psychologica, 240, 104042. 10.1016/j.actpsy.2023.104042 [DOI] [PubMed] [Google Scholar]
  10. Chen Q., Liang M., Li Y., Guo J., Fei D., et al. (2020). Mental health care for medical staff in China during the COVID-19 outbreak. The Lancet Psychiatry, 7(4), e15–e16. 10.1016/S2215-0366(20)30078-X [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Cheung T., Wong S. Y., Wong K. Y., Law L. Y., Ng K., Tong M. T., Wong K. Y., Ng M. Y., Yip P. S. F. (2016). Depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong: A cross-sectional study. International Journal of Environmental Research and Public Health, 13(8), 779. 10.3390/ijerph13080779 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Dastan N. B., Kaya F., Uluman O. T., Kiransal N. (2021). Psychosocial and mental effects of Covid-19 pandemic on nursing students in Turkey: A cross-sectional study. International Journal of Caring Sciences, 14(3), 1900. [Google Scholar]
  13. Điệp P. Q., Thăng C. V., Hạnh N. T. T., Thu B. M. (2021). Thực trạng trầm cảm, lo âu, stress ở sinh viên cao đẳng điều dưỡng chính quy trường cao đẳng y tế Bạch Mai và một số yếu tố liên quan năm 2021. Tạp chí Y học Cộng đồng, 62(7), 10.52163/yhc.v62i7 [DOI] [Google Scholar]
  14. Gao J., Wang F., Guo S., Hu F. (2021). Mental health of nursing students amid coronavirus disease 2019 pandemic. Frontiers in Psychology, 12, 699558. 10.3389/fpsyg.2021.699558 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hai N. T., Thi H. L., Tran Cong H. T., Thi V. T., Hua Thi L. O., Vo Le T. T., My T. T. (2022). Investigating effects of COVID-19 pandemic on the mental health of nursing students during remote learning: An experience from dong A university, Vietnam. SAGE Open Nursing, 8, 23779608221135437. 10.1177/23779608221135437 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hasuike M., Hara Y., Mori H. M., Ideguchi N., Shirai F., Yoshimura Y., Murakami I., Kawahata H., Aoki M., Ogihara T. (2021). Influence of new coronavirus pandemic on behavior and awareness of young nurses and nursing students in Japan. BMC Nursing, 20(1), 1–10. 10.1186/s12912-021-00724-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Huang P. C., Hung C. H., Chen G. W., Cashin C., Griffiths M. D., Yang W. C., Ko N. Y. (2022). COVID-19-related self-stigma, post-traumatic stress disorder, insomnia, and smartphone addiction among frontline government workers with COVID-19 pandemic control duties. Psychology Research and Behavior Management, 3069–3080. 10.2147/PRBM.S383842 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Huang Y., Zhao N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research, 288, 112954. 10.1016/j.psychres.2020.112954 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Kar B., Kar N., Panda M. C. (2023). Social trust and COVID-appropriate behavior: Learning from the pandemic. Asian Journal of Social Health and Behavior, 6(3), 93–104. 10.4103/shb.shb_183_22 [DOI] [Google Scholar]
  20. Khankeh H., Pourebrahimi M., Karibozorg M. F., Hosseinabadi-Farahani M., Ranjbar M., Ghods M. J., Saatchi M. (2022). Public trust, preparedness, and the influencing factors regarding COVID-19 pandemic situation in Iran: A population-based cross-sectional study. Asian Journal of Social Health and Behavior, 5(4), 154. 10.4103/shb.shb_155_22 [DOI] [Google Scholar]
  21. Kính T. Q. (2017). Nghiên cứu các yếu tố liên quan của stress, lo âu, trầm cảm đối với sinh viên Trường cao đẳng Y tế Tiền Giang năm 2016. http://benhvientamthantg.gov.vn/chi-tiet-tin?/nghien-cuu-cac-yeu-to-lien-quan-cua-stress-lo-au-tram-cam-doi-voi-sinh-vien-truong-cao-dang-y-te-tien-giang-nam-2016/8852784
  22. Kukreti S., Strong C., Chen J. S., Chen Y. J., Griffiths M. D., Hsieh M. T., Lin C. Y. (2023). The association of care burden with motivation of vaccine acceptance among caregivers of stroke patients during the COVID-19 pandemic: Mediating roles of problematic social media use, worry, and fear. BMC Psychology, 11(1), 157. 10.1186/s40359-023-01186-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kuru Alici N., Ozturk Copur E. (2021). Anxiety and fear of COVID-19 among nursing students during the COVID-19 pandemic: A descriptive correlation study. Perspectives in Psychiatric Care, 58, 141–148. 10.1111/ppc.12851 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lin Y. C., Lin C. Y., Fan C. W., Liu C. H., Ahorsu D. K., Chen D. R., Griffiths M. D. (2022). Changes of health outcomes, healthy behaviors, generalized trust, and accessibility to health promotion resources in Taiwan before and during COVID-19 pandemic: Comparing 2011 and 2021 Taiwan social change survey (TSCS) cohorts. Psychology Research and Behavior Management, 3379–3389. 10.2147/PRBM.S386967 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Liu C. H., Chen Y. J., Chen J. S., Fan C. W., Hsieh M. T., Lin C. Y., Pakpour A. H. (2022). Burdens on caregivers of patients with stroke during a pandemic: Relationships with support satisfaction, psychological distress, and fear of COVID-19. BMC Geriatrics, 22(1), 958. 10.1186/s12877-022-03675-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lovibond P. F., Lovibond S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343. 10.1016/0005-7967(94)00075-U [DOI] [PubMed] [Google Scholar]
  27. Marcén-Román Y., Gasch-Gallen A., Vela Martín de la Mota I. I., Calatayud E., Gómez-Soria I., Rodríguez-Roca B. (2021). Stress perceived by university health sciences students, 1 year after COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(10), 5233. 10.3390/ijerph18105233 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Matthews T., Danese A., Caspi A., Fisher H. L., Goldman-Mellor S., Kepa A., Moffitt T. E., Odgers C. L., Arseneault L. (2019). Lonely young adults in modern Britain: findings from an epidemiological cohort study. Psychological medicine, 49(2), 268–277. 10.1017/S0033291718000788 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Meng H., Xu Y., Dai J., Zhang Y., Liu B., Yang H. (2020). Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Research, 289, 112983. 10.1016/j.psychres.2020.112983 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Nayan M. I. H., Uddin M. S. G., Hossain M. I., Alam M. M., Zinnia M. A., Haq I., Methun M. I. H. (2022). Comparison of the performance of machine learning-based algorithms for predicting depression and anxiety among university students in Bangladesh: A result of the first wave of the COVID-19 pandemic. Asian Journal of Social Health and Behavior, 5(2), 75. 10.4103/shb.shb_38_22 [DOI] [Google Scholar]
  31. Nemati M., Ebrahimi B., Nemati F. (2020). Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Archives of Clinical Infectious Diseases, 15, e102848. 10.5812/archcid.102848 [DOI] [Google Scholar]
  32. Patelarou A., Mechili E. A., Galanis P., Zografakis-Sfakianakis M., Konstantinidis T., Saliaj A., Patelarou E. (2021). Nursing students, mental health status during COVID-19 quarantine: Evidence from three European countries. Journal of Mental Health, 30(2), 164–169. 10.1080/09638237.2021.1875420 [DOI] [PubMed] [Google Scholar]
  33. Pramukti I., Strong C., Sitthimongkol Y., Setiawan A., Pandin M. G. R., Yen C. F., Ko N. Y. (2020). Anxiety and suicidal thoughts during the COVID-19 pandemic: Cross-country comparative study among Indonesian, Taiwanese, and Thai university students. Journal of Medical Internet Research, 22(12), e24487. 10.2196/24487 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Prasiska D. I., Muhlis A. N. A., Megatsari H. (2022). Effectiveness of the emergency public activity restrictions on COVID-19 epidemiological parameter in East Java province, Indonesia: An ecological study. Asian Journal of Social Health and Behavior, 5(1), 33. 10.4103/shb.shb_90_21 [DOI] [Google Scholar]
  35. Rasmussen B., Hutchinson A., Lowe G., Wynter K., Redley B., Holton S., Kerr D. (2022). The impact of covid-19 on psychosocial well-being and learning for Australian nursing and midwifery undergraduate students: A cross-sectional survey. Nurse Education in Practice, 58, 103275. 10.1016/j.nepr.2021.103275 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Reverté-Villarroya S., Ortega L., Lavedán A., Masot O., Burjalés-Martí M. D., Ballester-Ferrando D., Botigué T. (2021). The influence of COVID-19 on the mental health of final-year nursing students: Comparing the situation before and during the pandemic. International Journal of Mental Health Nursing, 30(3), 694–702. 10.1111/inm.12827 [DOI] [PubMed] [Google Scholar]
  37. Roca J., Canet-Vélez O., Cemeli T., Lavedán A., Masot O., Botigué T. (2021). Experiences, emotional responses, and coping skills of nursing students as auxiliary health workers during the peak COVID-19 pandemic: A qualitative study. International Journal of Mental Health Nursing, 30(5), 1080–1092. 10.1111/inm.12858 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Sangma R. D., Kumar P., Nerli L. M., Khanna A. M., Vasavada D. A., Tiwari D. S. (2022). Social stigma and discrimination in coronavirus disease-2019 survivors and its changing trend: A longitudinal study at tertiary care center Gujarat, India. Asian Journal of Social Health and Behavior, 5(2), 68. 10.4103/shb.shb_12_22 [DOI] [Google Scholar]
  39. Shevlin M., McBride O., Murphy J., Miller J. G., Hartman T. K., Levita L., Mason L., Martinez A. P., McKay R., Stocks T. V. A., Bennett K. M., Hyland P., Karatzias T., Bentall R. P. (2020). Anxiety, depression, traumatic stress, and COVID-19 related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open, 6(6), e125. 10.1192/bjo.2020.109 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Shouli M. M., Ayed A., Shouli K. M., Issa B. M., Khraiwesh I. M. (2022). Health consequences of university employees post-COVID-19 vaccination at Palestinian universities. SAGE Open Nursing, 8, 23779608221144935. 10.1177/23779608221144935 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sultana M. S., Khan A. H., Hossain S., Ansar A., Sikder M. T., Hasan M. T. (2021). Prevalence and predictors of post-traumatic stress symptoms and depressive symptoms among Bangladeshi students during COVID-19 mandatory home confinement: A nationwide cross-sectional survey. Children and Youth Services Review, 122, 105880. 10.1016/j.childyouth.2020.105880 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Toqan D., Ayed A., Joudallah H., Amoudi M., Malak M. Z., Thultheen I., Batran A. (2022). Effect of progressive muscle relaxation exercise on anxiety reduction among nursing students during their initial clinical training: A quasi-experimental study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 00469580221097425. 10.1177/00469580221097425 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Toqan D., Ayed A., Malak M. Z., Hammad B. M., ALBashtawy M., Hayek M., Thultheen I. (2023). Sources of stress and coping behaviors among nursing students throughout their first clinical training. SAGE Open Nursing, 9, 23779608231207274. 10.1177/23779608231207274 [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Tsai C. S., Wang L. J., Hsiao R. C., Yen C. F., Lin C. Y. (2023). Psychological distress and related factors among caregivers of children with attention-deficit/hyperactivity disorder during the COVID-19 pandemic. European Child & Adolescent Psychiatry, 1–4. 10.1007/s00787-023-02220-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Ulenaers D., Grosemans J., Schrooten W., Bergs J. (2021). Clinical placement experience of nursing students during the COVID-19 pandemic: A cross-sectional study. Nurse Education Today, 99, 104746. 10.1016/j.nedt.2021.104746 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Vicerra P. M. M. (2022). Mental stress and well-being among low-income older adults during COVID-19 pandemic. Asian Journal of Social Health and Behavior, 5(3), 101. 10.4103/shb.shb_110_22 [DOI] [Google Scholar]
  47. Wang C., Pan R., Wan X., Tan Y., Xu L., McIntyre R. S., Choo F. N., Tran B., Ho R., Sharma V. K., Ho C. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behav Immun, 87, 40–48. 10.1016/j.bbi.2020.04.028 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. World Health Organization (2020). Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020 (No. WHO/2019-nCoV/MentalHealth/2020.1). World Health Organization. [Google Scholar]
  49. Yıldırım M., Akgül Ö, Geçer E. (2021). The effect of COVID-19 anxiety on general health: The role of Covid 19 coping (original article published in Turkish). International Journal of Mental Health and Addiction, 11, 1–12. 10.1007/s11469-020-00429-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Zhi X., Lu L., Pu Y., Meng A., Zhao Y., Cheng F., Zeng Y. (2022). Investigation and analysis of psychological stress and professional identity of nursing students during COVID-19 pandemic. Indian Journal of Experimental Biology (IJEB), 58(06), 426–432. 10.56042/ijeb.v58i06.65497 [DOI] [Google Scholar]
  51. Zhu Y., Wang H., Wang A. (2021). An evaluation of mental health and emotion regulation experienced by undergraduate nursing students in China during the COVID-19 pandemic: A cross-sectional study. International Journal of Mental Health Nursing, 30(5), 1160–1169. 10.1111/inm.12867 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from SAGE Open Nursing are provided here courtesy of SAGE Publications

RESOURCES