Compliance with recommendations limiting COVID-19 contagion among university students in Sweden: associations with self-reported symptoms, mental health and academic self-efficacy.

Anne H. Berman,Olof Molander,Naira Topooco,Lilian Granlund,Philip Lindner,Karin Engström,Marcus Bendtsen,Petra Lindfors,Claes Andersson

doi:10.1177/14034948211027824

Abstract

Aims:The COVID-19 containment strategy in Sweden uses public health recommendations relying on personal responsibility for compliance. Universities were one of few public institutions subject to strict closure, meaning that students had to adapt overnight to online teaching. This study investigates the prevalence of self-reported recommendation compliance and associations with self-reported symptoms of contagion, self-experienced effects on mental health and academic self-efficacy among university students in Sweden in May–June 2020.Methods:This was a cross-sectional 23 question online survey in which data were analysed by multinomial regression, taking a Bayesian analysis approach complemented by null hypothesis testing.Results:A total of 4495 students consented to respond. Recommendation compliance ranged between 70% and 96%. Women and older students reported higher compliance than did men and younger students. Mild to moderate COVID-19 symptoms were reported by 30%, severe symptoms by fewer than 2%; 15% reported being uncertain and half of the participants reported no symptoms. Mental health effects were reported by over 80%, and changes in academic self-efficacy were reported by over 85%; in both these areas negative effects predominated. Self-reported symptoms and uncertainty about contagion were associated with non-compliance, negative mental health effects, and impaired academic self-efficacy.Conclusions:Students generally followed public health recommendations during strict closure of universities, but many reported considerable negative consequences related to mental health and academic self-efficacy. Digital interventions should be developed and evaluated to boost coping skills, build resilience and alleviate student suffering during the pandemic and future similar crises.

Highlights

The COVID-19 pandemic has led to unprecedented restriction of individual movement, daily routines and economic activity
Such restrictions have varied between countries in the degree of coercion directed towards ordinary citizens, and it is unclear whether differences in the severity of measures have affected the spread of the pandemic; these circumstances have challenged thinking about public health actions on the individual, societal and governmental levels [1]
Earlier research from the severe acute respiratory syndrome (SARS) pandemic in Canada indicated that social restrictions in the form of home quarantine were associated with post-traumatic stress disorder (PTSD) and depression symptoms of clinical significance among about one-third of the general population [12], in alignment with current findings in Sweden [11]

Summary

Introduction

The COVID-19 pandemic has led to unprecedented restriction of individual movement, daily routines and economic activity. Such restrictions have varied between countries in the degree of coercion directed towards ordinary citizens, and it is unclear whether differences in the severity of measures have affected the spread of the pandemic; these circumstances have challenged thinking about public health actions on the individual, societal and governmental levels [1]. Date received September 2020; reviewed May 2021; accepted 8 June 2021 pandemic-related quarantine indicated that negative long-term effects most often ensue, but that presenting a clear official rationale for restrictions that are voluntary, rather than mandatory, can mitigate the psychological distress associated with quarantine [2, 3]. Of relevance is that other broad societal changes that occur during a pandemic can negatively affect mental health; for example, economic recession is associated with upward trends in the prevalence of suicides [13]

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Conclusion