INTRODUCTION

This age, in which cooperation and exchange among countries have accelerated with technological changes, has paved the way for diseases to find a way of easy and quick transmission. The best example of this is the Coronavirus disease-2019 (COVID-19) pandemic, which is still in effect today and started in Wuhan, China. The disease rapidly affected the whole world, and with the increase in the number of cases and deaths, the disease was declared as a pandemic by the World Health Organization on March 11, 2020¹.

The effects of the disease on the society, especially on health, social and psychological aspects, were felt. The uncertain and sudden change of the life order has affected the daily functioning, and the change in the ordinary situation in education and working life has affected the sociological structure and this has brought some global problems². Countries have sought to provide quality, fair and uninterrupted education, and online education has been started to be used instead of face-to-face education^2,3. It has been stated that compulsory social isolation has negative effects on learning, development and communication at every stage from primary education to higher education, mental health problems of the young population in particular have increased at least twice, and depression and anxiety have increased by 30-80% compared to adults^4,5.

It is reported that young adults exhibit higher levels of anxiety, depression, substance use and irregular eating habit during the university years compared to the general population, when they gain new experiences in terms of finding solutions to the changes and difficulties they encounter in their lives and it is suggested that there are significant changes in parameters such as anxiety, fear and worry in public health emergencies such as epidemics and pandemics^6-8. In the COVID-19 pandemic, it was observed that university students tried to adapt to online lessons and exams, and they were one of the groups that were most affected psychologically due to both the disruption of their routine and the unequal new conditions⁹. In addition, the fact that there are studies reporting a significant increase in the depression and anxiety levels and in the general suicidal tendency, observing an increase in the time of sleep but a worsening of its quality and a decrease in the quality of life reveals the seriousness of the issue^10,11. When it comes to university students, the negative effects of stress on health, emotions, learning and memory also gain importance¹². Studies examining the perceived stress and social isolation needs of university students living in various regions of Turkey and studying in different departments during the COVID-19 period were observed to be limited¹³. In this study, it is aimed to examine the psychological status and social relationship needs of university students in detail according to some demographic characteristics during this ongoing pandemic process.

MATERIALS AND METHODS

The research was designed as a prospective study and was carried out using a web-based questionnaire created by examining the literature. Volunteer participants reached through social media groups of university students were included in the survey. The survey was conducted in such a way that if they said yes to the “I have read, I approve” option, which was the purpose of the study and the informative text in the first part, they could continue. It was also stated in the informative text that personal and contact information was not collected from the participants, that the questions in the survey were not compulsory and that they could leave whenever they wanted.

Study Population and Sample

While determining the sampling criteria, groups that were socially severely affected by the pandemic conditions were evaluated and young people were decided according to the literature review. Since the socioeconomic criteria of the young people who went to and did not go to university were not the same, the young people who were not in the education life were not included in the sample, and the age range of 18-25 years, which covered the general age range of those who went to university, was chosen in order to obtain the data set for our purpose in a homogeneous and healthy way.

Based on 921,886 university students who settled in the university chosen as the population, or more than seven and a half million university students who were currently students, it was determined that at least 385 people were needed as the sample number, with 95% reliability and 5% confidence interval, while the mean and variance of the population were unknown¹⁴.

Data

University students at the age range of 18-25 years were reached through a web-based survey between January 1 and February 29, 2020 across Turkey. The Perceived Stress Scale (PSS) scores and the Need for Relatedness Scale (NRS) scores of the university students were measured, and demographic parameters (age, gender, faculty, region of residence, monthly income, and family history of COVID-19), which were thought to have an impact, were also added to the survey. In the 407 questionnaires collected, 5 people were excluded from the data set because they left their demographic characteristics and most of the scale questions blank, and analyses were carried out with 402 people. Since some of the scale questions were left blank, the PSS scale was studied with 399 people and the NRS scale with 390 people (acceptance subscale with 390, intimacy subscale with 393), and the gap filling method for missing data was not used.

Perceived Stress Scale

The PSS was originally developed by Cohen et al.¹⁵ in 1983, and its Turkish adaptation was published in 2013 by Eskin et al.¹⁶.

PSS, consisting of fourteen items, was created to measure how stressful the situations experienced by the individual were perceived. A 5-point Likert-type scale is applied to individuals to evaluate each item ranging from “Never (0)” to “Very often (4)”. In the scale, 7 items (4., 5., 6., 7., 9., 10. and 13.) with positive expressions are evaluated in reverse. The total score of the PSS-14 scale ranges from 0 to 56, and an increasing score indicates that the individual’s perceived stress is high.

Need for Relatedness Scale

It is a scale developed by Richer and Vallerand¹⁷ (1996) on the basis of the Self-Determination Theory, and its original form was developed in English in Canada as “The NRS-10”. It was adapted into Turkish by Karagüven et al.¹⁸ in 2020.

NRS-10 was created to evaluate the social relationship levels of individuals in different environments. It is a scale consisting of 10 items, 5 of which (items 1., 3., 5., 7., 9.) are included in the sub-dimension of “acceptance” and 5 of which (items 2., 4., 6., 8., 10.) in the sub-dimension of “intimacy”. The expression at the beginning of the scale (such as with my colleagues, with my schoolmates) can be changed so that the scale could be used easily in different environments. Each item is evaluated between 1 (strongly disagree) and 7 (strongly agree).

The scores of the NRS-10 scale range from 10 to 70, and the increasing scale score indicates a high level of social relationship.

For this study, official approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Haliç University with the number 242 on 24.12.2020.

Statistical Analysis

Descriptive statistics results were given as frequency and percentage for categorical variables, and as mean, standard deviation, median, minimum and maximum for continuous variables. The Shaphiro-Wilk test results were used to examine the normality distribution of continuous variables, and the comparison of continuous variables between the two groups was performed with the Independent Samples t-test for normally distributed data and with the Mann-Whitney U Test for not normally distributed data. The Pearson or Spearman’s correlation analysis was applied according to the distribution of the variables in the analysis of the correlation between the variables. The Cronbach’s alpha values of the scales were given and principal components, factor loads and explained coefficients of variance were calculated with the help of Factor Analysis. Statistical analyses were performed with the Statistics Package for Social Sciences (SPSS) version 24.0 and the R programming language (4.0.3 version) “psych” program, and the p<0.05 value was considered statistically significant.

RESULTS

Demographic characteristics of 402 students participating in the study are presented in Table 1. The mean age of the students was 20.22±1.58 years. There was no significant difference between 139 male students [20.34±1.76 20 (18-25) years] and 263 female students [20.16±1.48 20 (18-25) years] in terms of age (p=0.587). While 28.6% of the participating students had a family history of COVID-19, 71.4% did not.

The PSS and NRS scores are presented in Table 2 and it was seen that their averages were above the mean values of the scales (28 for PSS, 40 for NRS). Cronbach’s alpha values were calculated as 87% for PSS and 97% for NRS, and the scales were found to have high reliability (Table 2)¹⁹.

As a result of examining the scale scores according to demographic characteristics, a significant difference was found only between the genders in terms of PSS scores (p<0.001). It was observed that the PSS scores of the female students were higher than the PSS scores of the male students (Table 3).

In order to avoid problems in both meaning integrity and statistical analyses in group comparisons, the faculty type was grouped as “medical faculty and other”, as well as “medical faculty and health sciences faculty students and other”; region of residence as “Marmara Region and other”; and income status as “low (<2.200) and high (≥2.200)”. There was no significant difference in terms of PSS, NRS and NRS subscales (acceptance and intimacy) between those with and without a family history of COVID-19, between medical faculty students and others, between health sciences faculty students in addition to medical faculty students and others, between those residing in the Marmara region and other regions, and between those with low and high income (Tables 3, 4).

When medical faculty students were examined within themselves, it was found that the stress levels of female students were higher than those of male students, but there was no significant difference in terms of family history of COVID-19, income status and residence region (p<0.001, 0.780, 0.949, p 0.420, respectively).

When the relationship between the two scales was examined, a significant, reverse and very weak relationship was found between NRS and PSS (p<0.001, -0.208). It was observed that this relationship was insignificant only in male participants, but significant, reverse and very weak (-0.237) in female students. When examined in terms of COVID-19 history, a significant and reverse relationship, which was very weak in those without history of COVID-19 while weak in those with a history of COVID-19 although it was slightly higher, was found (-0.167, -0.344, respectively) (Table 5).

Factor Analysis, Principal Component Analysis

- For the NRS scale, the Cronbach’s alpha was 97%, the explained variance was 76%, the Kaiser-Meyer-Olkin (KMO) value was 0.952, and the Barlett’s test of Sphericity analysis result was p<0.001. Component coefficients varied between a minimum of 0.718 and a maximum of 0.926.
For the subscales, the Cronbach’s alpha values were observed as 94% for the acceptance subscale and 93% for the intimacy subscale.

- For the PSS scale, the Cronbach’s alpha was 87%, the explained variance was 54%, the KMO value was 0.905, and the Barlett’s test of Sphericity result was p<0.001.

DISCUSSION

In our study, which revealed that routine lives of 402 university students, whose average age was 20.22±1.5 years and 65.4% were female students, and who participated in the survey from different geographical regions and different faculties, were affected during the COVID-19 pandemic, and which evaluated the levels of social relations and stress that they experienced while adapting to digital transformations, it was found that PSS scores of female students were higher than those of male students.

As a result of the prospective cohort study conducted by Savage et al.²⁰ on the mental health and physical behaviors of university students during the pandemic, a decrease in the mental health of young people, students and women, who are more sensitive than the general society, and an increase in their stress and sedentary states were observed. Moreover, in the same study, it was stated that female students were more stressed than male students²⁰. In the current study, PSS scores of female students were detected to be higher, which was found to be consistent with the literature.

When only medical faculty students were examined within themselves, it was found that the stress levels of female students were higher than those of male students, but no significant difference was found in terms of income status. In the study conducted by Torun and Torun²¹ with medical faculty students, it was emphasized that the perceived stress level of female students was higher than that of male students, and that low income also affected students’ perceived stress and anxiety. The income level, which was found to be significant In a single-center study conducted with only medical faculty students, was observed to have lost its significance on COVID-19 considering the students studying in medical faculties throughout Turkey, and it was observed to be at a trend level among students studying in all regions and faculties in Turkey. It is thought that more comprehensive studies on perceived stress depending on income are needed.

In the study of perceived stress conducted by Tuğut et al.²² with a web-based survey on 295 university students studying only in the field of health, excluding the medical faculty, in a university in the period of COVID-19, and in the study of perceived stress conducted by Bayar et al.²³ on only 565 university students, mostly studying in the field of health at Mardin Artuklu University, it was stated that the PSS scores were above the average level.

Compared to the study conducted by Hancıoğlu²⁴ in 2017 with students at Ankara University Faculty of Political Sciences, Department of Business Administration before COVID-19, it was found that the stress perceived by university students during the COVID-19 period increased even more. In the PSS validation study conducted by Eskin et al.¹⁶ with students studying at Adnan Menderes University Aydın Health High School and Faculty of Science and Literature in 2013, it was observed that the perceived stress scores of university students during the pandemic were even higher. In our study, which also included students studying in health-related and other departments and from other regions, it was observed that university students’ PSS scores were even higher during the COVID-19 period. It was concluded that university students were negatively affected by the pandemic, independent of region, faculty, department and income level, except for gender.

Study Limitations

The lack of knowledge on the pre-pandemic stress and social relationship status of the university students participating in the study was determined as a limitation of the study.

CONCLUSION

As a result, in our study, an increase was observed in the stress and social needs scores of university students during the COVID-19 process, it was clearly observed that this increase was not a determinant in terms of demographic characteristics except for gender, and all university student groups were similarly affected by the restrictions brought by the pandemic. It is thought that there is a need to make common arrangements for university students in general, to consider the anxiety and stress parameters in their education lives, and to improve their psychological status.

Acknowledgement

We would like to thank Ass. Prof. Fulya Dal Yöntem for her important contribution to the initiation of this research, Ass. Prof. Nevra Alkanlı for her contribution to the important dynamics of the study, and our valuable participants for sharing their time and ideas with us.

Ethics

Ethics Committee Approval: For this study, official approval was obtained from the Non-Invasive Clinical Research Ethics Committee of Haliç University with the number 242 on 24.12.2020.

Informed Consent: Survey study.

Peer-review: Externally peer-reviewed.

Authorship Contributions

Concept - Design - Data Collection or Processing - Analysis or Interpretation - Literature Search - Writing: A.B., A.D.U., E.U., I.B., M.M., M.S.T., M.B.Ç., U.E.C., Z.B.Y.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.