Risk and protective factors for college students’ psychological health during the COVID-19 pandemic

Abstract

Objective
College students’ psychological health may be compromised due to the COVID-19 pandemic. Here, we aimed to identify risk (eg, perceived risk of contracting COVID-19) and protective factors (ie, social support, mindfulness) for positive (ie, subjective happiness, satisfaction with life) and negative (ie, depression, anxiety, stress) aspects of psychological health. Participants: Participants were 251 college students at a mid-Atlantic university. Method: Self-report online survey data were collected between March and May 2020 using established measures of risk perception, mindfulness, social support, and psychological health. Results: Greater perceived risk of contracting COVID-19 was associated with greater depression, anxiety, and stress. Greater mindfulness was a protective factor for psychological health. Greater social support was associated with less depression, and greater happiness and life satisfaction. Conclusions: Programs that teach students how to cultivate mindfulness and supportive relationships and reduce their risk of contracting COVID-19 may help protect against depression, stress, and anxiety.

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Risk and protective factors for college students’
psychological health during the COVID-19
pandemic
Ilana Haliwa , Rachael Spalding , Kelly Smith , Amanda Chappell & JoNell
Strough
To cite this article: Ilana Haliwa , Rachael Spalding , Kelly Smith , Amanda Chappell & JoNell
Strough (2021): Risk and protective factors for college students’ psychological health during the
COVID-19 pandemic, Journal of American College Health, DOI: 10.1080/07448481.2020.1863413
To link to this article: https://doi.org/10.1080/07448481.2020.1863413
Published online: 31 Jan 2021.
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REPORT
Risk and protective factors for college students’psychological health
during the COVID-19 pandemic
Ilana Haliwa, MS, MPH , Rachael Spalding, MS, Kelly Smith, BA, Amanda Chappell, MA, and
JoNell Strough, PhD
Department of Psychology, West Virginia University, Morgantown, West Virginia, USA
ABSTRACT
Objective: College students’psychological health may be compromised due to the COVID-19 pan-
demic. Here, we aimed to identify risk (eg, perceived risk of contracting COVID-19) and protective
factors (ie, social support, mindfulness) for positive (ie, subjective happiness, satisfaction with life)
and negative (ie, depression, anxiety, stress) aspects of psychological health. Participants:
Participants were 251 college students at a mid-Atlantic university. Method: Self-report online sur-
vey data were collected between March and May 2020 using established measures of risk percep-
tion, mindfulness, social support, and psychological health. Results: Greater perceived risk of
contracting COVID-19 was associated with greater depression, anxiety, and stress. Greater mindful-
ness was a protective factor for psychological health. Greater social support was associated with
less depression, and greater happiness and life satisfaction. Conclusions: Programs that teach stu-
dents how to cultivate mindfulness and supportive relationships and reduce their risk of contract-
ing COVID-19 may help protect against depression, stress, and anxiety.
ARTICLE HISTORY
Received 6 August 2020
Revised 20 November 2020
Accepted 6 December 2020
KEYWORDS
COVID-19; mental health;
mindfulness; social support
Introduction
The coronavirus (COVID-19) pandemic has the potential to
negatively impact psychological health.
1
Although morbid-
ity and mortality is widely publicized,
1
risk and protective
factors for psychological health have received less atten-
tion.
2,3
It is especially important to investigate such factors
among college students, considering the high incidence of
psychological disorders among this population,
4,5
which
maybecompoundedbyCOVID-19stressors.Indeed,fol-
lowing the COVID-19 outbreak, undergraduates in Spain
had higher depression, anxiety, and stress than faculty,
staff, and graduate students.
6
Further, COVID-19 may also
have implications for college students’happiness and life
satisfaction. Psychological health is more than the absence
of depression or anxiety. It also encompasses indicators of
well-being such as happiness and life satisfaction,
7
making
it important to investigate how COVID-19 relates to these
aspects of psychological health.
Research on risk and protective factors for psychological
health during the current and prior global epidemics (eg,
SARS, Ebola), has focused on the general population, not
college students. Greater perceived risk of contracting
COVID-19, worry about COVID-19, impact of COVID-19
on daily life, female gender, younger age, and lower income
were identified as risk factors.
8–11
These findings map on
to theory suggesting that perceived risk constitutes an
affective component (ie, associations with fear, worry, and
anxiety).
12
As greater daily stress is associated with
worsened mental health,
13
it follows that greater impact of
COVID-19 on daily life would also contribute to worsened
mental health outcomes.
Regarding protective factors, greater social support was
associated with better psychological well-being in survivors of
the 2003 SARS epidemic
14
and buffered against COVID-19-
related anxiety among Chinese college students.
9
Social sup-
port has been theorized to benefit mental health by providing
a context for affect, thought, and behavior regulation sur-
rounding stressors.
15
Mindfulness (ie, nonjudgmental assess-
ment of the present moment),
16
may support acceptance of
COVID-19 stressors, thus, buffering against poor mental
health outcomes associated with maladaptive interpretations
of stressors. Greater mindfulness is associated with higher
life satisfaction,
17
greater happiness,
18
and reduced depression
and anxiety.
19
The current study investigated risk and protective factors
for psychological health among college students during the
early months of the COVID-19 pandemic. Based on research
with other populations, we hypothesized that greater per-
ceived risk of contracting COVID-19, greater worry about
COVID-19, and greater perceived impact of COVID-19 on
personal life would be associated with worse psychological
health, while mindfulness and social support would be asso-
ciated with better psychological health. It is important to
investigate the generalizability of such associations among
college students given the unique stressors they face and the
high incidence of psychological disorders among this
ß2021 Taylor & Francis Group, LLC
CONTACT Ilana Haliwa ih0010@mix.wvu.edu Department of Psychology, West Virginia University, 53 Campus Drive, Morgantown, WV 26501, USA.
JOURNAL OF AMERICAN COLLEGE HEALTH
https://doi.org/10.1080/07448481.2020.1863413

population. Based on prior research, gender, income, and
race were included as covariates.
Method
Participants and procedure
Data were collected between March 3 2020 and May 10 2020.
College students (N¼262; M
age
¼19.62; SD ¼1.55) from a
large, public, Mid-Atlantic university in the United States pro-
vided informed consent and completed an online survey for
extra credit in a psychology course. One person who had not
heard of COVID-19, and ten inattentive participants
(described later) were excluded from the analyses (final
N¼251). See Table 1 for sample characteristics. Order of
presentation of measures was randomized. The study was
approved by the University’s Institutional Review Board (IRB).
Measures
The Depression Anxiety Stress Scale Short-Form
20
measured
depression (eg, I found it difficult to work up the initiative
to do things), anxiety (eg, I felt I was close to panic), and
stress (eg, I found it difficult to relax). Participants rated
symptoms over the past week on a scale from 1 ¼“Did not
apply to me at all”to 4 ¼“Applied to me very much, or
most of the time.”Higher sum scores on seven-item sub-
scales indicated higher levels of depression (a¼.886), anx-
iety (a¼.870), or stress (a¼.857).
The 12-item Multidimensional Scale of Perceived Social
Support
21
measured perceived social support (eg, I can
count on my friends when things go wrong) on a scale from
1¼“very strongly disagree”to 7 ¼“very strongly agree.”
Higher sum scores indicated greater perceived social support
(a¼.884).
The 10-item Cognitive and Affective Mindfulness
Scale–Revised
22
measured mindfulness. Participants rated
statements (eg, I try to notice my thoughts without judging
them) on a scale from 1 ¼“rarely/not at all”to 4 ¼“almost
always.”After reverse scoring one item, higher sum scores
indicated greater mindfulness (a¼.824).
The four-item Subjective Happiness Scale
23
measured
happiness. Participants rated statements (eg, Compared to
most of my peers, I consider myself: 1 ¼“less happy”to 7
¼“more happy”). With one item reverse scored, higher sum
scores indicated higher subjective happiness (a¼.829).
The five-item Satisfaction with Life Scale
24
measured life
satisfaction. Participants rated statements (eg, In most ways
my life is close to my ideal) on a scale from 1 ¼“Strongly
disagree”to 7 ¼“Strongly agree.”Higher sum scores indi-
cated greater life satisfaction (a¼.856).
COVID-19 items
Five single-item indicators assessed experience of the
COVID-19 pandemic. Three items were from Bruine de
Bruin.
8
The first assessed awareness of COVID-19; the other
two assessed COVID-19 risk perceptions using a validated
visual sliding-scale method.
25
Two items from Spalding
26
assessed participants’general experiences of COVID-19.
Awareness of COVID-19
Participants were asked, “Have you heard of the coronavirus
(COVID-19)?”and responded yes, no, or unsure.
8
One par-
ticipant who responded “no”was excluded from the analy-
ses; none responded “unsure.”
Risk of contracting COVID-19
Participants were asked, “On a scale of 0% to 100%, what is
the chance that you will get the coronavirus (COVID-19) in
the next three months?”
8
Higher ratings indicated greater
perceived likelihood of contracting the virus.
Risk of dying from COVID-19
Participants were asked, “On a scale of 0 to 100, if you do
get the coronavirus (COVID-19), what is the percent chance
you will die from it?”
8
Higher ratings indicated greater per-
ceived likelihood of dying.
Worry about COVID-19
Participants were asked, “On a scale from 0 to 10, how wor-
ried are you about coronavirus (COVID-19)?”Higher rat-
ings indicated greater worry.
Personal impact of COVID-19
Participants were asked, “On a scale from 0 to 10, to what
extent have you been personally affected by coronavirus
(COVID-19)?”Higher scores indicated greater per-
sonal impact.
Table 1. Means and standard deviations of demographics and main
study variables.
Measure MSDMinimum Maximum
Age 19.62 1.55 18 31
Contracting COVID-19 36.08 23.61 0 100
Risk of dying COVID-19 15.29 17.40 0 90
Worry about COVID-19 6.68 2.56 1 11
Personally affected COVID-19 5.15 3.27 1 11
Depression 12.29 4.44 7 27
Anxiety 11.09 4.37 7 27
Stress 13.29 4.55 7 26
Social support 75.25 13.40 24 91
Mindfulness 28.93 5.49 14 41
Happiness 4.97 1.27 2 7
Life satisfaction 24.36 6.35 5 35
n%
Gender
Female 213 81.3
Male 46 17.6
Race
White 235 89.7
Black 12 4.6
Asian 6 2.3
Other 8 3.1
Not reported 1 0.4
Hispanic/Latino
Yes 14 5.3
No 240 91.6
Not reported 8 3.1
2 I. HALIWA ET AL.

Demographic characteristics
Participants indicated their gender, age, marital status, edu-
cation level, and income level (Table 1).
Validity check
Participants completed three validity check items randomly
placed throughout the survey; participants who answered
more than one item incorrectly were excluded (N¼10).
Results
Data were screened for skewness and kurtosis; no adjust-
ments were required to normalize the distributions.
Descriptive statistics are shown in Table 1. On average, par-
ticipants reported 36% risk for contracting COVID-19 and a
15% risk of dying from COVID-19. Participants were not
extremely worried about COVID-19 (M¼2.56; range 1–11)
but reported being relatively affected by it (M¼5.15; range
1–11). Higher scores on each COVID-19 item (perceived
risk of contracting, perceived risk of dying, worry, personal
impact) was significantly correlated with greater depression
(r¼.15 to .26), anxiety (r¼.15 to .27), and stress (r¼.19
to .21), but not happiness or life satisfaction (see Table 2).
1
Greater mindfulness and perceived social support were sig-
nificantly correlated with less depression (r¼–.41 to –.49),
anxiety (r¼–.26 to –.37) and stress (r¼–.27 to –.42), and
greater happiness (r¼.47 to .48), and life satisfaction (r¼
.43 to .44).
Five multiple regression analyses tested the unique contri-
butions of risk and protective factors for predicting psycho-
logical health (see Table 3).
Depression
The model predicting depression was significant, F(9,
136) ¼13.32, p<.001, R
2
¼.43. Greater perceived
risk of contracting COVID-19 was associated with
reporting greater depression. Reporting greater social
support and mindfulness were associated with reporting
less depression.
Anxiety
The model predicting anxiety was significant, F(9, 136) ¼
6.76, p<.001, R
2
¼.26. Greater perceived risk of contract-
ing COVID-19 and greater reported worry about COVID-19
were associated with reporting greater anxiety. Greater
mindfulness was associated with less anxiety.
Stress
The model predicting stress was significant, F(9, 136) ¼
7.36, p<.001, R
2
¼.28. Greater perceived risk of con-
tracting COVID-19 was associated with reporting greater
stress. Greater mindfulness was associated with reporting
less stress.
Table 2. Correlation summary: Intercorrelations of predictor and outcome variables.
1234567891011121314
1. Anxiety –.66 .61 –.34 –.45 .21 .15.27 .17–.26 –.37 .01 –.00 .07
2. Stress ––.63 –.35 –.45 .20 .21 .19.14 –.27 –.42 –.02 –.03 .18
3. Depression –– ––.48 –.63 .18 .15.26 .26 –.41 –.49 .04 –.06 .12
4. Life satisfaction –– – – .59 –.08 –.03 –.10 –.14 .43 .44 –.10 .12 –.06
5. Happiness –– – – – –.11 –.08 –.06 –.12 .48 .47 –.01 .06 –.06
6. Contracting COVID-19 ––––––.27 .27 .33 –.11 –.13–.07 .08 –.00
7. Risk of dying COVID-19 –––––––.25 .12 –.04 –.09 .03 .01 .17
8. Worry about COVID-19 ––––––––.29 .03 –.08 .06 –.17.15
9. Personally affected COVID-19 ––––––––––.04 –.09 .12 –.04 .02
10. Social support ––––––––––.35 –.13–.04 .01
11. Mindfulness ––––––––––––.02 .07 –.19
12. Race –––––––––––––.09 –.06
13. Income ––––––––––––––.12
14. Gender ––––––––––– ––
Note:p<.05, p<.01. Values are Spearman’s rho correlations. N¼251.
Table 3. Regression summary: Predictors of mental health outcomes, including standardized beta and standard error.
Anxiety B(SE) Stress B(SE) Depression B(SE) Life satisfaction B(SE) Happiness B(SE)
Social support –.03 (.03) –.14 (.03) –.30 (.02) .31 (.04) .34 (.01)
Mindfulness –.36 (.07) –.37 (.07) –.45 (.06) .31 (.09) .38 (.02)
Risk of contracting COVID-19 .28 (.02) .19 (.02).15 (.01).05 (.02) –.04 (.00)
Risk of dying COVID-19 .01 (.02) .08 (.02) –.001 (.02) .02 (.03) –.03 (.01)
Worry about COVID-19 .20 (.15).11 (.15) .12 (.12) .05 (.21) .04 (.04)
Personally affected COVID-19 –.03 (.12) –.01 (.12) .09 (.10) .16 (.17) –.08 (.03)
Race .03 (1.19) .11 (1.20) .09 (1.02) .00 (1.71) –.16 (.33)
Income –.03 (.10) .03 (.10) –.03 (.08) .06 (.14) .09 (.03)
Gender –.07 (.89) .09 (.90) –.04 (.76) –.02 (1.28) .02 (.25)
Note:p<.05, p<.01, p<.001; N¼251.
1
The only exception was that perceived personal impact of COVID-19 was not
significantly correlated with stress.
JOURNAL OF AMERICAN COLLEGE HEALTH 3

Happiness
The model predicting happiness was significant, F(9, 136) ¼
8.04, p<.001, R
2
¼.30. Greater perceived social support and
mindfulness were associated with reporting greater happiness.
Satisfaction with life
The model for life satisfaction was significant, F(9, 136) ¼
6.24, p<.001, R
2
¼.25. Greater perceived social support
and mindfulness were associated with greater life satisfaction.
Comments
We identified risk and protective factors for psychological
health among U.S. college students during the early months
of the COVID-19 pandemic. Perceived risk was consistently
positively related to depression, anxiety, and stress, but not
happiness or life satisfaction. Mindfulness and social support
appeared to help buffer students against negative mental
health and were positively associated with happiness and
life-satisfaction. Mindfulness was previously shown to pro-
tect against stressors such as natural disasters.
27
Our study is
among the first to identify mindfulness as a protective factor
during COVID-19.
28
Our findings for social support suggest
that prior research based on the SARS outbreak in Hong
Kong and COVID-19 in China
9,15
generalize to U.S. col-
lege students.
Media depictions of U.S. college students often highlight
their relative lack of concern about COVID-19, yet our
results indicate that those who perceive greater risks of
COVID-19 may experience poorer psychological health.
These findings highlight the need for educational programs
and mental health services as students continue to navigate
campuses. Compared to programs that focus solely on risk
mitigation, those that focus on promoting mindfulness and
social support may boost happiness and life satisfaction
while also reducing stress, anxiety and depression. Recent
research has identified fear of COVID-19 as a predictor of
compliance with protective measures such as use of PPE
and social distancing.
10
Thus, educational programs must
balance mitigation of fear and anxiety with information
about preventive behaviors that reduce risk. As social dis-
tancing is necessary to help prevent the spread of COVID-
19, programs that encourage cultivating social support using
computer-mediated communication may be necessary.
10
Similarly, remote programming, such as smartphone-based
mindfulness trainings, may help buffer against depression,
stress, and anxiety during the pandemic.
29
Limitations and future directions
As with any study, ours has limitations. Due to our correl-
ational design, causality cannot be inferred. Further, our
sample was demographically homogenous (majority female
and non-Hispanic White). Minority groups in the United
States are disproportionately affected by the COVID-19 pan-
demic,
30,31
making it important to investigate psychological
health among minority students in future research. Finally,
research is needed to evaluate risk and protective factors for
psychological heath as the pandemic progresses, as associa-
tions among risk perceptions, personal impact of COVID-
19, and life satisfaction may change over time.
Conclusions
The present study provides a unique contribution to the
limited existing literature, by demonstrating that lesser per-
ceived risk of contracting COVID-19, greater mindfulness,
and greater social support are associated with better psycho-
logical health among college students during the COVID-19
pandemic. These findings may be used to inform prevention
and intervention strategies (eg, mindfulness training, strat-
egies for maintaining social support while social distancing)
may help buffer students against psychological distress while
promoting happiness and life-satisfaction. Such efforts are
particularly important as college students navigate campuses
in the midst of the COVID-19 pandemic.
Conflict of interest disclosure
The authors have no conflicts of interest to report. The authors con-
firm that the research presented in this article met the ethical guide-
lines, including adherence to the legal requirements, of the United
States of America and received approval from the Institutional Review
Board of West Virginia University.
Funding
This research did not receive any specific grant from funding agencies
in the public, commercial, or not-for-profit sectors.
ORCID
Ilana Haliwa http://orcid.org/0000-0001-7948-5845
Data availability
The datasets generated during and analyzed during the current study
are available from the corresponding author on reasonable request.
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