One year after the first cases of COVID-19: Factors influencing the anxiety among Kosovar university students

Introduction: One year after the first COVID-19 cases in Kosovo, we aimed to discover the anxiety level of university students and explore factors influencing their anxiety. Methods: This is a cross-sectional study. 897 students (M = 21.06, SD = 4.41), from six universities in Kosovo completed the 7-item Generalized Anxiety Disorder Scale and a sociodemographic survey through a web-based Google form. Descriptive, Pearson chi-square, t-Test, ANOVA, linear and multiple regressions were used. Results: We found that 73.5% of the full sample experience anxiety, respectively 12.9 % of them severe anxiety, 22.2 % moderate, and 38.4 % mild anxiety, with female students showing higher levels of anxiety symptoms. Moreover, students in master studies (20%), students who have been infected with COVID-19 (18.9%), students having a relative (14.8%) or having an acquaintance infected with COVID-19 (15.7%), were more likely to be severely anxious (P < 0.05). Students from Medical Faculty, Law and Arts also showed higher level of severe anxiety than the students of Technical faculties and Faculty of Education (P = 0.001). Students with history of infection with COVID-19 showed higher severe anxiety for their family members (14.8%), friends (15.7%) and themselves (18.9%) than the full sample. Anxiety was predicted by being infected with COVID-19 (P =0.000), having friends infected (P = 0.000) and by gender (P = 0.000). Conclusion: The current study found that most of the students are experiencing anxiety at some levels. Continuous observation of students’ psychological health and other deeper studies is recommended. In the meantime, psychological services for students should be provided. Journal of Health and Social Sciences 2021; 6,2:241-254 The Italian Journal for Interdisciplinary Health and Social Development 242 INTRODUCTION This challenging COVID-19 pandemic has heavily influenced the mental health of people all around the globe, either directly or indirectly [1–4]. Some categories of workers have been threatened in a particular way leading to a high incidence of anxiety, sleep problems, depression, and post-traumatic stress disorders, especially among health care professionals [5, 6]. Although the university students were not the most endangered group of the population, this is also true for them [7, 8]. University students constitute a population that is particularly vulnerable in terms of mental health, one that even before the pandemic showed a high prevalence of mental disorders [9]. Several studies have reported that students have consistently higher levels of mental health problems than the general population [10, 11], which may be partly due to the lack of implementation of a well-designed, and often expensive, preventive measures [12]. The number of papers that have addressed the issue of how students’ psychological health been affected by the pandemic and the confinement is not satisfactory. The fear of the COVID-19 infection, unexpected lockdown, and sudden implementation of online classes may lead to stress, anxiety, and other emotional problems among students [13, 14]. Odriozola-Gonzáleza et al. [13] reported that out of 2,530 members of a university in Spain, moderate to extremely severe scores of anxiety, depression, and stress were reported by 21.34%, 34.19% and 28.14% of the respondents, respectively and a total of 50.43% of participants presented moderate to severe impact of the COVID-19 outbreak. Moreover, many universities suspended normal class-based teaching and moved online, with the result that the lives of students changed drastically [15] at both academic and personal levels [16]. Bruffaerts et al [17] found that university students were more vulnerable and easily affected by a pandemic. This new academic and personal life, since college students are also vulnerable to major changes Competing interests none declared. Copyright © 2021 Merita Shala et al. Edizioni FS Publishers This is an open access article distributed under the Creative Commons Attribution (CC BY 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. See http:www.creativecommons.org/licenses/by/4.0/. Cite this article as: Shala M, Çollaku Jetishi P, Hoxha A, Balaj Bllaca S. Preteni D. One Year after the First Cases of COVID-19: Factors Influencing Anxiety among Kosovar University Students. J Health Soc Sci. 2021;6(2):241-254 Author Contributions: Conceptualization, study design, data collection, methodology, formal analysis, writingoriginal draft, writingreview & editing: MS. Data collection, writingreview & editing: PJ-C, FH and SB-B. Data collection, supervision, writingreview & editing: DP. TAKE-HOME MESSAGE In this Kosovo-based study, about 73.5% of college students, mainly female, have experienced such high levels of anxiety even 1 year after COVID-19. The government and universities should collaborate to provide high-quality, timely crisis-oriented psychological services for students. Received: 27/04/2021 Accepted: 28/05/2021 Published Online: 01/06/2021 DOI 10.19204/2021/nyrf10 Journal of Health and Social Sciences 2021; 6,2:241-254 The Italian Journal for Interdisciplinary Health and Social Development 243 in their routine and, as a consequence, to the psychological impact of the pandemic [18], negatively disrupted their psychosocial functioning, thus altering the social integration of some individuals [19]. Specifically related to this study, the literature has documented the negative influence of pandemics on students’ psychological wellbeing. There are several studies [20, 21] that reported high levels of anxiety during the COVID-19 outbreak on Chinese undergraduate students. In one of them, out of 7,143 students studied, 0.9% had severe anxiety, 2.7% had moderate anxiety, and 21.3% had mild anxiety. They also reported that some factors, such as place of residence, source of parental income, whether living with parents or not, and having a relative or an acquaintance infected with COVID-19, were associated with increased anxiety [22]. Another study reported that out of 3,611 university students from all over China, 557 of them (15.43%) met the cutoff of 50 and were screened positive for anxiety [23]. Saravanan et al, [24] found in their study that out of the 433 students, 15.9% of students in the United Arab Emirates universities, were anxious, while another study on anxiety experienced by university students during the COVID-19 pandemic in Saudi Arabia, found that out of 400 students, about 35% of them reported moderate to extreme levels of anxiety, which was highly associated with age, sex, and level of education [23]. Sundarasen et al, [24] in their study found that among 983 University Students in Malaysia, 20.4%, 6.6%, and 2.8% experienced minimal to moderate, marked to severe, and most extreme levels of anxiety. Almost the same results, showed also another study [25] who investigated 3,881 college students, and found that the overall incidence of anxiety was 26.60%, and the incidences of mild, moderate and severe anxiety were 23.19%, 2.71%, and 0.70%, respectively. Higher levels of anxiety were found also in a sample of 2,038 students from more than 180 universities in China, who reported that with respect to prevalence of clinically-relevant symptoms, 15.5% of them, presented clinically relevant anxiety symptoms [26] while almost the same results, showed the study of 433 university students in the United Arab Emirates, were 15.9% of students were anxious [22]. In one of the most comprehensive and large-scale study [8], 39.8% of 30,383 students from 62 countries experienced anxiety, 45.2% of them experienced boredom, 39.1% frustration, 25.9% anger, 18.8% hopelessness and 10.0% shame. In the same study, the highest levels of anxiety were found in South America (65.7%) and Oceania (64.4%), followed by North America (55.8%) and Europe (48.7%). Least anxious were students from Africa (38.1%) and Asia (32.7%). While another meta-analytic study [27], found that the pooled prevalence of anxiety in twenty studies with a sample size of 84,097 university students, was 39.4%. Almost the same level of anxiety was reported for Italian university students, with results of 35.33% of them classified as anxious [28]. Around 18.7% of 198 Spanish University students were suffering severe anxiety and 70.2% were suffering either mild or moderate anxiety and that individuals have higher anxiety levels associated with disimproved sleep quality [29], while among Greece students the level of anxiety was found to be 42.5% [30]. Approximate results were also shown for Turkish students, who reported the anxiety levels of 12.57%, 35.75%, 28.77% and 22.91% for normal, mild, moderate and severe anxiety, respectively [31]. In the first month of cases with COVID-19 in Kosovo, Arënliu and Bërxulli [32], reported the findings from an online survey conducted with the students of the University of Prishtina ‘Hasan Prishtina’ in Kosovo, on the level of psychological distress, as a result of citizen movement restrictions of during the COVID-19 pandemics. Out of 158 students, 24.7% reported mild psychological distress, 13.3% reported moderate psychological distress and 11.4 reported severe psychological distress. Arenliu et al expanded their study and examined the level of anxiety and depression among 904 students of one public uniJournal of Health and Social Sciences 2021; 6,2:241-254 The Italian Journal for Interdisciplinary Health and Social Development 244 versity in Kosovo, during the initial phase of the outbreak and blockage of the COVID19 pandemic [33]. The study took place during the lockdown measures, included strict movement restrictions, were individuals had the right to be outside 90 min per day. Results showed that 202 (22.4%) students, reported mild levels of anxiety, 98 (10.9%) reported moderate levels of anxiety, and 33 (3.7%) reported severe levels of