Stress, Depression, Public Stigma, and Their Associated Factors Among University Students in Thailand After the COVID-19 Pandemic
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Abstract
University students have been faced with challenges, including COVID-19 public stigma, which results in increased stress and depression. Few studies have assessed stress, depression, and public stigma of COVID-19 after the pandemic. This paper investigated stress, depression, and public stigma of COVID-19 among Thai University students. A cross-sectional study was conducted using an online questionnaire to assess stress, depression, and public stigma resulting from COVID-19 among Thai university students between 15 and 30 August 2022. The questionnaire was developed by the Department of Mental Health, Ministry of Public Health, Thailand. Public stigma was measured by the COVID-19 public stigma scale. The effects of public COVID-19 stigma on stress and depression were analyzed using multivariable multi-level logistic regression. A total of 2,422 students completed the questionnaire. After multivariable analysis adjustment, students who experienced COVID-19 public stigma showed increased stress (AOR = 1.53; 95% CI [1.27–1.84]) and depression levels (AOR = 1.34; 95% CI [1.01–1.79]). Those who lived with high-risk COVID-19 individuals showed significant risk factors for stress, depression, and public stigma of COVID-19, while income presented the reverse effect. Those vaccinated with over two doses showed significantly reduced chances of depression. The COVID-19 public stigma plays a vital role in stress and depression levels among Thai university students. To mitigate stress and depression, an evaluation of public stigma is needed even after the pandemic. Further cohort studies are required to verify long-term results.
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References
• Amir Hamzah, N. S., Nik Farid, N. D., Yahya, A., Chin, C., Su, T. T., Rampal, S. R. L., & Dahlui, M. (2019). The prevalence and associated factors of depression, anxiety and stress of first year undergraduate students in a public higher learning institution in Malaysia. Journal of Child and Family Studies, 28(12), 3545–3557. https://doi.org/10.1007/s10826-019-01537-y
• Bagcchi, S. (2020). Stigma during the COVID-19 pandemic. The Lancet Infectious Diseases, 20(7), 782. https://doi.org/10.1016/S1473-3099(20)30498-9
• Balasubramanian, I., Faheem, A., Padhy, S. K., & Menon, V. (2022). Psychiatric adverse reactions to COVID-19 vaccines: A rapid review of published case reports. Asian Journal of Psychiatry, 71, Article 103129. https://doi.org/10.1016/j.ajp.2022.103129
• BBC News. (2022, April 26). Ukraine war to cause biggest price shock in 50 years - World Bank. https://www.bbc.com/news/business-61235528
• Bhanot, D., Singh, T., Verma, S. K., & Sharad, S. (2021). Stigma and discrimination during COVID-19 pandemic. Frontiers in Public Health, 8, Article 577018. https://www.frontiersin.org/articles/10.3389/fpubh.2020.577018
• Biswas, M. A. A. J., Hasan, M. T., Samir, N., Alin, S. I., Homaira, N., Hassan, M. Z., Khatun, M. R., Anjum, A., Hossain, S., Koly, K. N., Safa, F., Alam, S. F., Rafi, M. A., Osman Biswas, M. A., Yasmin, F., Podder, V., Trisa, T. I., Azad, D. T., Nodi, R. N., … Ahmed, H. U. (2022). The prevalence and associated factors of depressive symptoms among medical students in Bangladesh during the COVID-19 pandemic: A cross-sectional pilot study. Frontiers in Public Health, 9, Article 811345. https://doi.org/10.3389/fpubh.2021.811345
• Bo, H. X., Li, W., Yang, Y., Wang, Y., Zhang, Q., Cheung, T., Wu, X., & Xiang, Y. T. (2021). Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine, 51(6), 1052–1053. https://doi.org/10.1017/S0033291720000999
• Boonvisudhi, T., & Kuladee, S. (2017). Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital. PLOS ONE, 12(3), Article e0174209. https://doi.org/10.1371/journal.pone.0174209
• Burki, T. K. (2020). Coronavirus in China. The Lancet Respiratory Medicine, 8(3), 238. https://doi.org/10.1016/S2213-2600(20)30056-4
• Cheema, S., Maisonneuve, P., Abraham, A., Chaabna, K., Tom, A., Ibrahim, H., Mushannen, T., Yousuf, W., Lowenfels, A. B., & Mamtani, R. (2022). Factors associated with perceived stress in Middle Eastern university students. Journal of American College Health, 70(8), 2462–2469. https://doi.org/10.1080/07448481.2020.1865979
• Chen, S., Aruldass, A. R., & Cardinal, R. N. (2022). Mental health outcomes after SARS-CoV-2 vaccination in the United States: A national cross-sectional study. Journal of Affective Disorders, 298(Pt A), 396–399. https://doi.org/10.1016/j.jad.2021.10.134
• Chhetri, B., Goyal, L. M., Mittal, M., & Battineni, G. (2021). Estimating the prevalence of stress among Indian students during the COVID-19 pandemic: A cross-sectional study from India. Journal of Taibah University Medical Sciences, 16(2), 260–267. https://doi.org/10.1016/j.jtumed.2020.12.012
• Costa, C., Briguglio, G., Mondello, S., Teodoro, M., Pollicino, M., Canalella, A., Verduci, F., Italia, S., & Fenga, C. (2021). Perceived stress in a gender perspective: A survey in a population of unemployed subjects of Southern Italy. Frontiers in Public Health, 9, Article 640454. https://doi.org/10.3389/fpubh.2021.640454
• Department of Mental Health. (2016). Bàep thót sòp dâan sùk khâap jìt [Mental Health Tests]. https://dmh.go.th/test/
• Ebert, D. D., Buntrock, C., Mortier, P., Auerbach, R., Weisel, K. K., Kessler, R. C., Cuijpers, P., Green, J. G., Kiekens, G., Nock, M. K., Demyttenaere, K., & Bruffaerts, R. (2019). Prediction of major depressive disorder onset in college students. Depression and Anxiety, 36(4), 294–304. https://doi.org/10.1002/da.22867
• Evans-Lacko, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Benjet, C., Bruffaerts, R., Chiu, W. T., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hu, C., Karam, E. G., Kawakami, N., Lee, S., Lund, C., Kovess-Masfety, V., Levinson, D., … Thornicroft, G. (2018). Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: Results from the WHO World Mental Health (WMH) surveys. Psychological Medicine, 48(9), 1560–1571. https://doi.org/10.1017/S0033291717003336
• Fonseca-Pedrero, E., Díez-Gómez, A., Pérez-Albéniz, A., Al-Halabí, S., Lucas-Molina, B., & Debbané, M. (2023). Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents. Psychiatry Research, 328, Article 115486. https://doi.org/10.1016/j.psychres.2023.115486
• Fuchs, E., & Flügge, G. (2004). Cellular consequences of stress and depression. Dialogues in Clinical Neuroscience, 6(2), 171–183. https://doi.org/10.31887/DCNS.2004.6.2/efuchs
• Gao, W., Ping, S., & Liu, X. (2020). Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. Journal of Affective Disorders, 263, 292–300. https://doi.org/10.1016/j.jad.2019.11.121
• Ge, Y., Xin, S., Luan, D., Zou, Z., Bai, X., Liu, M., & Gao, Q. (2020). Independent and combined associations between screen time and physical activity and perceived stress among college students. Addictive Behaviors, 103, Article 106224. https://doi.org/10.1016/j.addbeh.2019.106224
• Gloster, A. T., Lamnisos, D., Lubenko, J., Presti, G., Squatrito, V., Constantinou, M., Nicolaou, C., Papacostas, S., Aydın, G., Chong, Y. Y., Chien, W. T., Cheng, H. Y., Ruiz, F. J., Garcia-Martin, M. B., Obando-Posada, D. P., Segura-Vargas, M. A., Vasiliou, V. S., McHugh, L., Höfer, S., … Karekla, M. (2020). Impact of COVID-19 pandemic on mental health: An international study. PLOS ONE, 15(12), Article e0244809. https://doi.org/10.1371/journal.pone.0244809
• Graves, B. S., Hall, M. E., Dias-Karch, C., Haischer, M. H., & Apter, C. (2021). Gender differences in perceived stress and coping among college students. PLOS ONE, 16(8), Article e0255634. https://doi.org/10.1371/journal.pone.0255634
• Grover, S., Singh, P., Sahoo, S., & Mehra, A. (2020). Stigma related to COVID-19 infection: Are the health care workers stigmatizing their own colleagues? Asian Journal of Psychiatry, 53, 102381. https://doi.org/10.1016/j.ajp.2020.102381
• Haddad, C., Bou Malhab, S., Malaeb, D., Sacre, H., Saadeh, D., Mourtada, V., & Salameh, P. (2021). Stigma toward people with COVID-19 among the Lebanese population: A cross-sectional study of correlates and mediating effects. BMC Psychology, 9(1), Article 164. https://doi.org/10.1186/s40359-021-00646-y
• Janoušková, M., Pekara, J., Kučera, M., Kearns, P. B., Šeblová, J., Wolfová, K., Kuklová, M., & Šeblová, D. (2024). Experiences of stigma, discrimination and violence and their impact on the mental health of health care workers during the COVID-19 pandemic. Scientific Reports, 14(1), Article 10534. https://doi.org/10.1038/s41598-024-59700-5
• Kaewpila, W., Thaipisuttikul, P., Awirutworakul, T., Jumroonrojana, K., Pitidhammabhorn, U., & Stevens, F. (2020). Depressive disorders in Thai medical students: An exploratory study of institutional, cultural, and individual factors. International Journal of Medical Education, 11, 252–260. https://doi.org/10.5116/ijme.5fbe.4ce5
• Kaufman, K. R., Petkova, E., Bhui, K. S., & Schulze, T. G. (2020). A global needs assessment in times of a global crisis: World psychiatry response to the COVID-19 pandemic. BJPsych Open, 6(3), Article e48. https://doi.org/10.1192/bjo.2020.25
• Khan, K. S., Mamun, M. A., Griffiths, M. D., & Ullah, I. (2022). The mental health impact of the COVID-19 pandemic across different cohorts. International Journal of Mental Health and Addiction, 20(1), 380–386. https://doi.org/10.1007/s11469-020-00367-0
• Kolkijkovin, V., Phutathum, S., Natetaweewat, N., Joodthong, P., Phaisanwongdee, P., Nateetaweewat, P., & Jantarawattanawanich, A. (2019). Prevalence and associated factors of depression in medical students at Faculty of Medicine Vajira Hospital, Urban University. Journal of the Medical Association of Thailand, 102(9), 104–108.
• Kraft, J. D., Grant, D. M., White, E. J., Taylor, D. L., & Frosio, K. E. (2021). Cognitive mechanisms influence the relationship between social anxiety and depression among college students. Journal of American College Health, 69(3), 245–251. https://doi.org/10.1080/07448481.2019.1661844
• Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), Article e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
• Levy, P. S., & Lemeshow, S. (2008). Sampling of populations: Methods and applications (4th ed.). Wiley.
• Li, J.-Q., Wang, Y.-H., Lu, Q.-D., Xu, Y.-Y., Shi, J., Lu, L., & Bao, Y.-P. (2019). Prevalence of psychological distress in type II diabetes in China: A systematic review and meta-analysis. Heart and Mind, 3(4), 147–152. https://doi.org/10.4103/hm.hm_67_19
• Li, Y., Zhao, J., Ma, Z., McReynolds, L. S., Lin, D., Chen, Z., Wang, T., Wang, D., Zhang, Y., Zhang, J., Fan, F., & Liu, X. (2021). Mental health among college students during the COVID-19 pandemic in China: A 2-wave longitudinal survey. Journal of Affective Disorders, 281, 597–604. https://doi.org/10.1016/j.jad.2020.11.109
• Luo, M., Guo, L., Yu, M., Jiang, W., & Wang, H. (2020). The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public—A systematic review and meta-analysis. Psychiatry Research, 291, Article 113190. https://doi.org/10.1016/j.psychres.2020.113190
• Ma, Z., Zhao, J., Li, Y., Chen, D., Wang, T., Zhang, Z., Chen, Z., Yu, Q., Jiang, J., Fan, F., & Liu, X. (2020). Mental health problems and correlates among 746,217 college students during the coronavirus disease 2019 outbreak in China. Epidemiology and Psychiatric Sciences, 29, Article e181. https://doi.org/10.1017/S2045796020000931
• Mahase, E. (2020). Covid-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ, 368, Article m1036. https://doi.org/10.1136/bmj.m1036
• Marazziti, D., Avella, M. T., Mucci, N., Della Vecchia, A., Ivaldi, T., Palermo, S., & Mucci, F. (2021). Impact of economic crisis on mental health: A 10-year challenge. CNS Spectrums, 26(1), 7–13. https://doi.org/10.1017/S1092852920000140
• Marlow, M., Skeen, S., Grieve, C. M., Carvajal-Velez, L., Åhs, J. W., Kohrt, B. A., & Tomlinson, M. (2023). Detecting depression and anxiety among adolescents in South Africa: Validity of the isiXhosa Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Journal of Adolescent Health, 72(1), S52–S60. https://doi.org/10.1016/j.jadohealth.2022.06.028
• Maser, B., Danilewitz, M., Guérin, E., Findlay, L., & Frank, E. (2019). Medical student psychological distress and mental illness relative to the general population: A Canadian cross-sectional survey. Academic Medicine, 94(11), 1781–1791. https://doi.org/10.1097/ACM.0000000000002958
• Moitra, M., Owens, S., Hailemariam, M., Wilson, K. S., Mensa-Kwao, A., Gonese, G., Kamamia, C. K., White, B., Young, D. M., & Collins, P. Y. (2023). Global mental health: Where we are and where we are going. Current Psychiatry Reports, 25(7), 301–311. https://doi.org/10.1007/s11920-023-01426-8
• Nochaiwong, S., Ruengorn, C., Awiphan, R., Kanjanarat, P., Ruanta, Y., Phosuya, C., Boonchieng, W., Nanta, S., Chongruksut, W., Thavorn, K., Wongpakaran, N., & Wongpakaran, T. (2021). COVID-19 Public Stigma Scale (COVID-PSS): Development, validation, psychometric analysis, and interpretation. BMJ Open, 11(11), Article e048241. https://doi.org/10.1136/bmjopen-2020-048241
• Nochaiwong, S., Ruengorn, C., Thavorn, K., Hutton, B., Awiphan, R., Phosuya, C., Ruanta, Y., Wongpakaran, N., & Wongpakaran, T. (2021). Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: A systematic review and meta-analysis. Scientific Reports, 11(1), Article 10173. https://doi.org/10.1038/s41598-021-89700-8
• Ochnik, D., Rogowska, A. M., Kuśnierz, C., Jakubiak, M., Schütz, A., Held, M. J., Arzenšek, A., Benatov, J., Berger, R., Korchagina, E. V., Pavlova, I., Blažková, I., Aslan, I., Çınar, O., & Cuero-Acosta, Y. A. (2021). Mental health prevalence and predictors among university students in nine countries during the COVID-19 pandemic: A cross-national study. Scientific Reports, 11(1), Article 18644. https://doi.org/10.1038/s41598-021-97697-3
• Peluso, E. de T., & Blay, S. L. (2009). Public stigma in relation to individuals with depression. Journal of Affective Disorders, 115(1–2), 201–206. https://doi.org/10.1016/j.jad.2008.08.013
• Phomprasith, S., Karawekpanyawong, N., Pinyopornpanish, K., Jiraporncharoen, W., Maneeton, B., Phinyo, P., & Lawanaskol, S. (2022). Prevalence and associated factors of depression in medical students in a Northern Thailand university: A cross-sectional study. Healthcare, 10(3), Article 488. https://doi.org/10.3390/healthcare10030488
• Rahman, M. A., Dhira, T. A., Sarker, A. R., & Mehareen, J. (2022). Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh. PLOS ONE, 17(6), Article e0269634. https://doi.org/10.1371/journal.pone.0269634
• Richter-Levin, G., & Xu, L. (2018). How could stress lead to major depressive disorder? IBRO Reports, 4, 38–43. https://doi.org/10.1016/j.ibror.2018.04.001
• Ruengorn, C., Awiphan, R., Phosuya, C., Ruanta, Y., Thavorn, K., Wongpakaran, N., Wongpakaran, T., & Nochaiwong, S. (2022). Disparities and factors associated with coronavirus disease-2019-related public stigma: A cross-sectional study in Thailand. International Journal of Environmental Research and Public Health, 19(11), Article 6436. https://doi.org/10.3390/ijerph19116436
• Ryu, S., & Fan, L. (2023). The relationship between financial worries and psychological distress among U.S. adults. Journal of Family and Economic Issues, 44(1), 16–33. https://doi.org/10.1007/s10834-022-09820-9
• Schomerus, G., Evans-Lacko, S., Rüsch, N., Mojtabai, R., Angermeyer, M. C., & Thornicroft, G. (2015). Collective levels of stigma and national suicide rates in 25 European countries. Epidemiology and Psychiatric Sciences, 24(2), 166–171. https://doi.org/10.1017/S2045796014000109
• Shang, Y., Li, H., & Zhang, R. (2021). Effects of pandemic outbreak on economies: Evidence from business history context. Frontiers in Public Health, 9, Article 632043. https://doi.org/10.3389/fpubh.2021.632043
• Simonse, O., Van Dijk, W. W., Van Dillen, L. F., & Van Dijk, E. (2022). The role of financial stress in mental health changes during COVID-19. NPJ Mental Health Research, 1(1), Article 15. https://doi.org/10.1038/s44184-022-00016-5
• Siripongpan, A., Phattaramarut, K., Namvichaisirikul, N., Poochaya, S., & Horkaew, P. (2022). Prevalence of depression and stress among the first year students in Suranaree University of Technology, Thailand. Health Psychology Research, 10(3), Article 35464. https://doi.org/10.52965/001c.35464
• Srichan, P., Ruanjai, T., Khunthason, S., & Apidechkul, T. (2020). Factors associated with high-to-severe stress among university students in Northern Thailand. Journal of the Medical Association of Thailand, 103(6), 594–603.
• Sun, Y., Bao, Y., Ravindran, A., Sun, Y., Shi, J., & Lu, L. (2019). Mental health challenges raised by rapid economic and social transformations in China: A systematic review. The Lancet, 394, S52. https://doi.org/10.1016/S0140-6736(19)32388-8
• Wahid, S. S., Ottman, K., Hudhud, R., Gautam, K., Fisher, H. L., Kieling, C., Mondelli, V., & Kohrt, B. A. (2021). Identifying risk factors and detection strategies for adolescent depression in diverse global settings: A Delphi consensus study. Journal of Affective Disorders, 279, 66–74. https://doi.org/10.1016/j.jad.2020.09.098
• Wang, C., Wen, W., Zhang, H., Ni, J., Jiang, J., Cheng, Y., Zhou, M., Ye, L., Feng, Z., & Ge, Z. (2021). Anxiety, depression, and stress prevalence among college students during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of American College Health, 1–8. https://doi.org/10.1080/07448481.2021.1967559
• Wickramasinghe, A., Essén, B., Surenthirakumaran, R., & Axemo, P. (2023). Prevalence of depression among students at a Sri Lankan university: A study using the Patient Health Questionnaire-9 (PHQ-9) during the COVID-19 pandemic. BMC Public Health, 23(1), Article 528. https://doi.org/10.1186/s12889-023-15427-y
• Wongpakaran, N., Oon-Arom, A., Karawekpanyawong, N., Lohanan, T., Leesawat, T., & Wongpakaran, T. (2021). Borderline personality symptoms: What not to be overlooked when approaching suicidal ideation among university students. Healthcare, 9(10), Article 1399. https://www.mdpi.com/2227-9032/9/10/1399
• World Bank. (2022, October 21). Rural Thailand faces the largest poverty challenges with high income inequality. https://www.worldbank.org/en/news/press-release/2022/10/21/rural-thailand-faces-the-largest-poverty-challenges-with-high-income-inequality
• World Health Organization. (2022, June 8). Weekly epidemiological update on COVID-19—8 June 2022. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---8-june-2022
• Yokoya, S., Maeno, T., Sakamoto, N., Goto, R., & Maeno, T. (2018). A brief survey of public knowledge and stigma towards depression. Journal of Clinical Medicine Research, 10(3), 202–209. https://doi.org/10.14740/jocmr3282w
• Yuan, K., Huang, X. L., Yan, W., Zhang, Y. X., Gong, Y. M., Su, S. Z., Huang, Y. T., Zhong, Y., Wang, Y. J., Yuan, Z., Tian, S. S., Zheng, Y. B., Fan, T. T., Zhang, Y. J., Meng, S. Q., Sun, Y. K., Lin, X., Zhang, T. M., Ran, M. S., … Lu, L. (2022). A systematic review and meta-analysis on the prevalence of stigma in infectious diseases, including COVID-19: A call to action. Molecular Psychiatry, 27(1), 19–33. https://doi.org/10.1038/s41380-021-01295-8
• Zhang, T. M., Fang, Q., Yao, H., & Ran, M. S. (2021). Public stigma of COVID-19 and its correlates in the general population of China. International Journal of Environmental Research and Public Health, 18(21), Article 11718. https://doi.org/10.3390/ijerph182111718