ABSTRACT
Aim:
The spread of infectious diseases has become inevitable with the increase in international cooperation, commerce and cultural values via the technological developments through the World. Coronavirus disease-2019 (COVID-19) pandemic has created stress and anxiety all over the World. Young adults are one of the most affected social groups in the isolation days. This study aimed to evaluate the university students’ perceived stress and need for relatedness with the profound change in educational and social life conditions.
Materials and Methods:
In order to determine the socialization needs and stress levels of university students, university students throughout Turkey were reached. Demographic characteristics, and the scores of Perceived Stress Scale and The Need for Relatedness Scale were collected by applying a web-based questionnaire in 402 students.
Results:
It was observed that the COVID-19 timeframe increased the stress levels and social needs of university students. The perceived stress of female students was found to be higher than that of male students (p<0.001) while no statistically significant difference was found among regions and departments.
Conclusion:
It has become necessary to consider the fact that the educational lives of university students are affected by the parameters of anxiety, stress and needs during this new normalization process and has become necessary to improve their psychological status.
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 education2,3. 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 adults4,5.
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 pandemics6-8. 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 issue10,11. 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.
GİRİŞ
Teknolojik değişimler ile ülkeler arasındaki iş birliği ve alışverişin hız kazandığı bu çağ, hastalıkların da kendilerine kolayca ve hızlıca bulaş yolu bulmasına zemin hazırlamıştır. Bunun en güzel örneği günümüzde hala etkisini sürdürmekte olan ve Çin Wuhan’da başlayan Koronavirüs hastalığı-2019 (COVID-19) pandemisidir. Hastalık hızla tüm dünyayı etkisi altına almış, olgu ve ölüm sayılarının artması ile 11 Mart 2020 tarihinde Dünya Sağlık Örgütü tarafından hastalık pandemi olarak ilan edilmiştir1.
Hastalığın toplum üzerinde başta sağlık olmak üzere sosyal ve psikolojik açıdan etkileri hissedilmiştir. Yaşamsal düzenin belirsiz ve ani değişimi günlük işleyişleri, eğitim ve çalışma hayatındaki olağan durumun değişmesi ise sosyolojik yapıyı etkilemiş ve bu da bazı küresel sorunları beraberinde getirmiştir2. Ülkeler kaliteli, adil ve kesintisiz eğitim sağlamanın yolunu aramışlar ve yüz yüze eğitim yerini çevrimiçi eğitime bırakmıştır2,3. Zorunlu sosyal izolasyonun ilköğretimden yükseköğretime kadar her aşamada öğrenme, gelişme ve iletişim üzerinde olumsuz etkileri olduğu, özellikle genç nüfusun ruh sağlığı sorunlarının en az iki katı arttığı, depresyon ve anksiyetenin ise yetişkinlere kıyasla %30-80 arasında arttığı ifade edilmiştir4,5.
Genç yetişkinlerin hayatlarında karşılaştıkları değişikliklere ve zorluklara çözüm üretme bakımından yeni deneyimler kazandıkları üniversite döneminde, topluma oranla daha yüksek düzeyde kaygı, depresyon, madde kullanımı ve düzensiz beslenme sergiledikleri bildirilmekte, epidemi ve pandemi gibi halk sağlığı açısından acil durumlarda da kaygı, korku, endişe gibi parametrelerinde anlamlı değişimler olduğu ileri sürülmektedir6-8. COVID-19 pandemisinde üniversite öğrencilerinin çevrimiçi derslere ve sınav düzenine adapte olmaya çalıştıkları, hem düzenlerinin bozulması hem de yeni koşulların eşit olmaması nedeniyle psikolojik olarak en çok etkilenen gruplardan biri olduğu gözlenmiştir9. COVID-19 sürecinde üniversite öğrencilerinin depresyon ve kaygı düzeylerinde anlamlı artışlar olduğunu belirten, ayrıca genel intihar eğiliminde artış bildiren, uyku miktarının arttığını ama kalitesinin kötüleştiğini ve yaşam kalitesinde düşüş olduğunu gözlemleyen çalışmaların olması konunun ciddiyetini de gözler önüne sermektedir10,11. Söz konusu üniversite öğrencileri olunca stresin sağlık, duygular, öğrenme, bellek üzerindeki olumsuz etkileri de ayrıca önem kazanmaktadır12. Türkiye’nin çeşitli bölgelerinde yaşayan ve farklı bölümlerde okuyan üniversite öğrencilerinin COVID-19 döneminde algıladıkları stres ve sosyal izolasyon gereksinimlerinin incelendiği çalışmaların kısıtlı olduğu gözlemlenmiştir13. Bu çalışmada etkileri devam eden bu pandemi sürecinde, üniversite öğrencilerinin psikolojik durumları ve sosyal ilişki gereksinimlerinin, bazı demografik özelliklere göre ayrıntılı irdelenmesi amaçlanmıştır.
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.
TARTIŞMA
Farklı coğrafi bölge ve farklı bölümlerden ankete katılan, yaş ortalaması 20,22±1,5 yıl ve %65,4’ü kız öğrenci olan 402 üniversite öğrencisinin COVID-19 pandemi süresince rutin düzenlerinin etkilenmiş olduğunu ortaya koyan ve dijital dönüşümlere uyum sağlamada yaşadıkları stres ve sosyal ilişki düzeylerinin ölçüldüğü çalışmamızda kız öğrencilerin ASÖ puanının erkek öğrencilerden daha yüksek olduğu bulundu.
Savage ve ark.’nın20 üniversite öğrencilerinin pandemi sırasında ruh sağlığı ve fiziksel davranışları üzerinde yaptıkları prospektif kohort çalışma sonucunda, topluma nazaran daha duyarlı olan gençlerin, öğrencilerin ve kadınların ruh sağlığında düşüş, stres ve sedanter durumlarında artış gözlemlenmiş ve ASÖ ölçeği kullanılarak kız öğrencilerin erkek öğrencilerden daha stresli oldukları ifade edilmiştir. Çalışmada kız öğrencilerin ASÖ puanı daha yüksek olup alan yazın ile uyumlu bulunmuştur.
Sadece tıp fakültesi öğrencileri kendi içinde irdelendiğinde de kız öğrencilerin stres düzeylerinin erkek öğrencilerden daha yüksek olduğu bulundu, fakat gelir durumu bakımından anlamlı bir fark bulunmadı. Torun ve Torun’un21 tıp fakültesinde okuyan öğrenciler ile yaptıkları çalışmada da kız öğrencilerin algıladıkları stres düzeyi, erkek öğrencilerininkinden daha yüksek bulunmakla beraber düşük gelirin de öğrencilerin algıladıkları stres ve kaygı üzerinde etkili olduğu vurgulanmıştır. Tek merkezli ve sadece tıp fakültesinde okuyan öğrenciler ile yapılan çalışmada anlamlı bulunan gelir düzeyinin, Türkiye genelindeki tıp fakültelerinde okuyan öğrenciler açısından bakıldığında COVID-19 üzerindeki anlamlılığını yitirdiği, Türkiye’deki tüm bölge ve bölümlerde okuyan öğrenciler arasında ise trend düzeyde olduğu gözlemlenmiştir. Gelir durumuna bağlı olarak algılanan stres ile ilgili daha kapsamlı çalışmalara ihtiyaç duyulduğu düşünülmektedir.
Tuğut ve ark.’nın22 bir üniversitenin tıp fakültesi hariç sadece sağlık alanında okuyan 295 üniversite öğrencisiyle web tabanlı anket ile yürüttüğü COVID-19 dönemi algılanan stres çalışmasında ve Bayar ve ark.’nın23 sadece Mardin Artuklu Üniversitesi’nde sağlık alanında okuyan öğrencilerin ağırlıklı olduğu 565 öğrenci ile yaptıkları algılanan stres çalışmasında, ASÖ puanlarının orta düzeyin üstünde olduğu ifade edilmiştir.
COVID-19 öncesi, 2017 yılında Hancıoğlu24 tarafından Ankara Üniversitesi Siyasal Bilgiler Fakültesi işletme bölümü öğrencileri ile yapılmış çalışma ile kıyaslandığında, COVID-19 döneminde üniversite öğrencilerinin algıladıkları stresin daha da arttığı bulunmuştur. Eskin ve ark.16 tarafından 2013 yılında Adnan Menderes Üniversitesi Aydın Sağlık Yüksek Okulu ve Fen-Edebiyat Fakültesinde okuyan öğrenciler ile yapılan ASÖ validasyon çalışmasında da pandemi sürecinde üniversite öğrencilerinin algıladıkları stres puanlarının daha da yüksek olduğu gözlemlenmiştir. Türkiye genelinde sağlık ve sağlık alanı dışında diğer bölümlerde ve bölgelerde okuyan öğrencileri de kapsayan çalışmamızda üniversite öğrencilerinin COVID-19 döneminde ASÖ puanının daha da yüksek olduğu gözlemlendi. Üniversite öğrencilerinin cinsiyet hariç bulundukları bölge, okul, bölüm ve gelir düzeyinden bağımsız olarak pandemiden negatif anlamda etkilendikleri sonucuna varıldı.
Çalışmanın Kısıtlılıkları
Çalışmaya katılan üniversite öğrencilerinin pandemi öncesi stres ve sosyal ilişki durumlarının bilinmemesi çalışmanın kısıtlılığı olarak belirlenmiştir.
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.
