The current study assessed the effects of COVID-19 on student mental health. Results showed that COVID-19 had a significant impact upon depression, anxiety and Smartphone use/addiction. The proportion of the 2021 group who met clinical thresholds for depression was significantly higher, reaching 44%. Furthermore, worryingly, half of our COVID group were classified as being addicted to their smartphone. We also found significant correlation between mental health problems and smartphone usage, showing a clear association between increases in smartphone use and increases in depression and anxiety.
The findings of the current study corroborated both Fried et al. [29] and Evans et al. [8] findings that depressive symptoms have increased during COVID-19. Of particular interest was the significant increase in moderate-severe depression levels between groups: an increase of 14.0%. There are no studies to date which have examined differences between groups of UK students cross-sectionally before and during the full pandemic. However, studies such as Elmer et al. [30] do report similar findings in a Swiss sample, showing increased depression and anxiety in an ‘early’ COVID-19 cohort group compared cross-sectionally with pre-COVID-19 students. Furthermore, although Fried et al., [29] observed decreases in anxiety, loneliness, and COVID-19-related concerns, during the transition to a partial Covid ‘lockdown’ in the Netherlands, conversely, they also saw other mental health variables, such as stress levels, remained stable, or in the case of depressive symptoms, increase. Their analysis identified potential vicious cycles between mental health variables and being alone, which predicted concerns about COVID-19 and was followed by further mental health problems.
This converging evidence highlights the clear negative impact of the pandemic on mental health and should trigger future research to investigate this further. There was also as expected a strong significant positive correlation between depression and anxiety, indicating a high level of comorbidity for these conditions. Importantly, the prevalence rates for depression and anxiety in the 2020 group was already higher than in the general population showing that students on average have poorer mental health in comparison to the adult population. This is in line with the findings of Thorley [12] who found that in England, 19% of 16–24-year-olds experience a mental health condition, Among this age group, 28% of women experience mental health problems, compared to 10% of men. The number of students who disclose a mental health condition to their university has also increased dramatically in the past 10 years, increasing almost fivefold.
The results from the current study support Ithnain et al.’s. [31] findings—that for students in Malaysia that there was a statistically significant positive relationship between smartphone addiction with anxiety and depression, and that smartphone addiction was also found as a predictor of both anxiety and depression. Similarly, Elhai et al. [18] found that depression and anxiety were related to problematic smartphone use. The significant increase in problematic smartphone use between groups also aligns with reports of smartphone use increasing during the pandemic (e.g., Zuckerman [32]) and could be due to the lack of opportunities for face-to-face communication. However, one limitation of measuring ‘smartphone use’ is that this term can cover a range of areas that may have variable effects on mental health. Indeed, evidence has found that social networking was the preferred activity for problematic smartphone users (Sohn et al. [22]), with gaining peer acceptance as the primary cause of smartphone overuse (Lee & Lee [33]). Therefore, it could be that social media use is driving the high prevalence rates of mental health problems, rather than smartphone use per se.
Our findings could be due to the students being part of a rigorous course which has become increasingly complex with the challenge of remote learning. Therefore, this sample may not generalize to the general population. Moreover, due to the anonymous nature of the study, students may have been more inclined to give truthful responses, which could further account for the high prevalence rates.
Limitations of the current study arise in terms of the over-representation of female participants in both groups. It is reported that females experience more mental health problems than males (e.g., Kuehner [34]; Li and Graham [35]), however this could be due to an increased likelihood of disclosure. Furthermore, there could be gender differences in smartphone use, such that male students with smartphone addiction are more likely to use gaming apps, whereas females prefer to use social media (Chen et al. [36]). Additionally, it should be noted that the current study is not based on longitudinal data, but on two cross-sectional studies, and hence any differences in the outcome measures between the groups must be tempered by the potential for underlying individual differences between the groups. Hence we suggest further research within this domain should focus on medium to long term longitudinal approaches.
The present findings should be of interest to universities, highlighting a critical time to intervene to safeguard their students. Thorley [12] has highlighted a 94% increase in demand for University counselling services, in some universities, up to 1 in 4 students are using, or waiting to use, counselling services. Broadly, we recommend that Universities should create campus environments to promote positive mental health, emphasising time away from smartphones. From a clinical perspective, our findings are particularly concerning, reflecting an urgent need for interventions. In addition to CBT and mindfulness interventions to improve mental health, research (e.g., Lan et al. [37]; Young [38]) also suggests that mindfulness and cognitive-behavioural techniques can be utilised as smartphone addiction interventions, to indirectly treat depression and anxiety in students. These findings should be used to demonstrate a growing public health concern that should inform public health policy to prevent a post-COVID-19 mental health crisis in UK universities.