Health consequences of COVID-19 on university students: effects on the lifestyle and psychological health – COV’Etu

Axis 1. In order to understand the long-term consequences of COVID-19, this first research axis aims to: 1. assess the psychological state (e.g., anxiety, well-being) and lifestyle (diet, sedentary lifestyle, alcohol consumption) of French university students at different times during the pandemic; and 2. Explore the individual factors (e.g., coping) and situational factors (e.g., housing size, health problems) involved.

Axis 2. This second line of research includes two interventional studies and aims to evaluate the effects of two programs on students' lifestyle and psychological status.
Study 1 of axis 2. Our first intervention consists of a program focused on stress and learning that also provides a space for student exchange. It consists of 9 video vignettes of about 10 minutes duration that are accompanied by complementary resources (e.g., websites, other videos, documents, exercises). The main objective of this intervention is to prevent alterations in students' psychological health and improve their learning strategies. Initially, our proposal included two groups: a group of students who benefited from the program (Experimental Group) and a group of students who did not (Control Group). After obtaining the agreement of the University of Nîmes, we proposed to the interested students to integrate a teaching unit (UE) on the management of emotions and learning. Thus, we finally constituted three groups of students. Following a recruitment phase, the program began on September 30, 2021. To date, the pre-intervention evaluations have been carried out with 159 students
Study 2 of Axis 2. This second intervention consists of an innovative 8-week physical activity program based on co-construction with students. The main objective of this intervention is to prevent health deterioration in students, and more specifically to reduce their sedentary lifestyle, increase their level of physical activity and improve their physical health. Two groups were initially planned: a group of students benefiting from the program (experimental group) and a group of students not benefiting from it (control group). Our goal was to include 45 students in each group and within 10 days we received 110 enrollments in the program. The 110 students were randomized according to gender and age. Due to a number of withdrawals for various reasons (e.g., scheduling constraints, lack of time, misunderstanding of the program), our final sample consisted of 51 students, 27 of whom participated in the program (experimental group) and 24 of whom received no intervention (control group).

Results axis 1. For the first two measurement times, our data highlight very high rates of anxiety during the March/April 2021 lockdown (Q1), including 22.9% of students with possible anxiety symptoms and 44.1% with definite anxiety symptoms. During the June 2021 decontainment (T2), the prevalence of student anxiety symptoms decreased sharply, and increased slightly again in October 2021 (T3, a period without containment and with mostly face-to-face classes). Despite this increase, the rates observed in Q3 remain lower than those in Q1, highlighting the effect of confinement on these symptoms, and to a lesser extent, the effect of returning to school. For our first two measurement times, we observe a similar trajectory for depressive symptoms, namely high rates during the March/April 2021 confinement and a decrease in the prevalence of depressive symptoms during deconfinement. However, unlike anxiety, in T3, the prevalence of depressive symptoms remains the same as in T2. In other words, it appears that depressive symptoms are closely related to being confined, and not dependent on being in or out of class. A similar pattern appears to emerge for levels of well-being and social support, with an increase in both dimensions during the two unconfined periods (T2 and T3), and no distinction between them, and lower levels during the confinement period (T1).

We are currently conducting comparative analyses between data collected in 2020 (prior to this project) and 2021 (collected as part of this project). As a reminder, in 2020, we conducted longitudinal data collection during the same periods of the year as those studied in this project. Our results show overall higher rates of anxiety and depressive symptoms in 2021 than in 2020, with an increase in the latter during periods of confinement. In the same way, the levels of concern for the health of their relatives measured in 2021 are slightly higher than those of 2020. A scientific paper incorporating these results is currently being written and we plan to submit it by the end of December 2021.

The two Axis 2 studies are currently underway.

Actions planned for Axis 1. The next and final collection will take place in December (Q4). In early 2022, we will therefore be able to conduct longitudinal analyses of our 4 measurement times conducted during 2021, in accordance with the objectives stated in our proposal.

Planned actions for Axis 2 - Study 1. After December 16, the date of the last video, the post-disposal quantitative evaluations will be conducted, and interviews will be conducted in January with student volunteers. Once all data is collected, scoring and data analysis will be conducted. The beginning of 2021 will then be devoted to scientifically evaluating the effects of this program.

Actions planned for Axis 2 - Study 2. The post-deployment assessments and questionnaires will be conducted between November 29 and mid-December. Once all the data has been collected, the scoring and analysis of the data will be carried out in order to allow a scientific valorisation of the effects of this device. In the same vein, the last results of the workshops are being processed and a manuscript aiming to valorize them is being written. The enthusiasm generated within the experimental group regarding this device has encouraged us to continue the proposed activities. It is planned that these activities will complement those currently offered by the University Physical and Sports Activities Service.

To date, four papers have been published based on the data collected in 2020. These were therefore not directly funded by this project, but they have laid the groundwork for it. .
1. Le Vigouroux, S., Goncalves, A., & Charbonnier, E. (2021). The Psychological Vulnerability of French University Students to the COVID-19 Confinement. Health Education & Behavior, 1090198120987128.
2. Goncalves, A., Le Vigouroux, S., & Charbonnier, E. (2021). University Students’ Lifestyle Behaviors during the COVID-19 Pandemic: A Four-Wave Longitudinal Survey. International journal of environmental research and public health, 18(17), 8998.
3. Charbonnier, E., Le Vigouroux, S., & Goncalves, A. (2021). Psychological Vulnerability of French University Students during the COVID-19 Pandemic: A Four-Wave Longitudinal Survey. International Journal of Environmental Research and Public Health, 18(18), 9699.
4. Charbonnier, E., Le Vigouroux, S., & Goncalves, A. (2021). Étudiants en temps de confinement et au-delà. La Presse Médicale Formation.

Three manuscripts are in progress

1. An article aimed at valorizing the data collected during the co-construction workshop. Title: Designing a physical activity program for students: a participatory design approach. Targeted journal: Frontiers in Public Health (call for papers «Physical Activity and Lifestyle Sustainability: From Childhood to Old Age«)
2. An article presenting the methodology of the Unimes en Forme program. Title: Promoting physical activity among university students with a co-constructed program during Covid-19 pandemic: Protocol for a Randomised controlled trial. Targeted journal: JMIR Research Protocols.
3. An article presenting a comparative analysis of student health between 2020 and 2021. Title: Emotional state and adjustment of French university students during the COVID-19 pandemic: comparison of four time points during the first two years of the pandemic. Targeted journal: Journal of public health

Two proposals were submitted in response to the call for papers of the 30th European Congress of Psychiatry:
1. Promoting physical activity among university students with a co-constructed program during Covid-19 pandemic.
2. Student mental health during the first two years of the COVID 19 pandemic

A video aimed at the restitution of the co-construction sessions has been put online: youtu.be/JFyeydn0qVQ

Since the beginning of the pandemic, university students have faced many challenges and without any preparation. COVID-19 has brought about a digital revolution in higher education (Strielkowski, 2020). However, distance learning was not without consequences on student stress (IAU, 2020). This confronts students with new obstacles (e.g., technological, personal, family; Baticulon et al., 2020). Several authors (Lee, 2020; Sahu, 2020; Zhai & Du, 2020) have highlighted the various challenges faced by university students, as well as their negative effects on their mental health. In addition, studies conducted during the first lockdown all show a deterioration in students' mental health (Essadek & Rabeyron, 2020; Husky et al., 2020; Le Vigouroux et al., 2021; Odriozola-González et al., 2020). This may be explained in part by the fact that people who were experiencing high levels of psychological distress prior to the pandemic are the most vulnerable (Druss, 2020; Yao et al., 2020), and before COVID-19, university students were already identified as a vulnerable population (see literature review: Paula et al., 2020). In the same line, the COVID-19 pandemic and e-learning has greatly changed the lifestyles of students. During the lockdown, an increase of sedentary behavior, a reduction in physical activity and a stronger tendency to move towards unhealthy diet has been demonstrated among students (Ammar et al., 2020; Bentlage et al., 2020; Castañeda-Babarro et al., 2020). Reducing travel, closing sports halls, confinement periods, curfew or distance learning are a series of measures that have been taken to reduce the circulation of the virus, but which have led to profound and rapid negative changes in lifestyles.
In sum, the deleterious effects of the pandemic on students' health are now evident. However, some areas of research are still under-explored. 1. The majority of research is largely descriptive and do not identify the factors involved in the deterioration of students' health; 2. All studies were conducted during the first lockdown and we have no knowledge of the long-term effects of the pandemic; 3. To date, no interventional studies have been conducted to prevent the deterioration of students' health. Our project proposes to address these three gaps and it is part of the topic “prevention, control and social dynamics”. Our proposal includes two axes of research. The first axis aims to identify, in a longitudinal way, the role of individual factors (e.g., coping, sex), and situational factors (e.g., symptoms of COVID, health concerns) on students' psychological health (e.g., anxiety, well-being) and lifestyle (e.g., sedentary behavior, alcohol), over the course of the pandemic.This first axis will provide a better understanding of the short- and long-term consequences on the health and well-being of university students. Our second line of research evaluates the health effects of two programs (one focused on stress and learning, the other on physical activity). Our results could provide decision support for universities to reduce the impact of the pandemic on students. Finally, our project adopts a pluridisciplinary approach by mobilizing clinical psychology, health psychology, cognitive psychology, social innovation by design, nutrition and physical activity.