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  1. Kamaludin K, Chinna K, Sundarasen S, Khoshaim HB, Nurunnabi M, Baloch GM, et al.
    Heliyon, 2020 Nov;6(11):e05339.
    PMID: 33134570 DOI: 10.1016/j.heliyon.2020.e05339
    This study examined how university students in Malaysia coped with the psychological impact of the COVID-19 pandemic and restrictions on movement (also known as MCO). A total of 983 students participated in a survey conducted online between April 20 and May 24, 2020. The psychological impact was measured using Zung's Self-Rating Anxiety Scale (SAS). The students were assessed on the usage of adaptive (humanitarian and seeking social support) and maladaptive coping strategies (acceptance and mental disengagement). The results showed that the students used maladaptive coping strategies more than adaptive coping strategies to deal with anxiety caused by the pandemic and the effect of restriction of movement. Seeking social support and acceptance coping strategies were significantly associated with the level of anxiety. The student's gender, age, ethnicity, level and type of study, and living arrangement were associated with coping strategies. The students' selection of coping strategies mirrors typical Asian culture, that is, submissiveness. The study proposes several practical and professional suggestions to address students' mental health issues.
  2. Far Abid Hossain S, Nurunnabi M, Sundarasen S, Chinna K, Kamaludin K, Baloch GM, et al.
    J Public Health Res, 2020 Nov 17;9(Suppl 1):1911.
    PMID: 33575227 DOI: 10.4081/jphr.2020.1911
    Background: The socio-psychological impact of COVID-19 has affected the whole world. Bangladesh, one of the most dangerous places as stated by WHO, was first infected at the beginning of March 2020, later than other countries. Bangladesh is now one of the 20 most affected countries in the world, but the psychological effects for university students during the epidemic period are not researched. Design and methods: To address this gap, the present study attempts to discover the socio-psychological impact of COVID-19 on university students in Bangladesh. We conducted an online survey using a questionnaire with a simple random sampling technique and we received 474 responses. Results: In this study, numerous psychological concerns were reported. The study is limited to university students, which may affect the generalizability of the research. Conclusions: Our findings suggest a need to build awareness of the mental health implications of the pandemic for university students.
  3. Baloch GM, Sundarasen S, Chinna K, Nurunnabi M, Kamaludin K, Khoshaim HB, et al.
    PeerJ, 2021;9:e10612.
    PMID: 33604167 DOI: 10.7717/peerj.10612
    BACKGROUND: As of the present, the twenty-first century is experiencing what may be one of its most devastating events, in respect to infected and dead people by the virus. Now known to the world as COVID-19, the devastating disease of what has become a pandemic started its spread from Wuhan, China and swiftly engulfed the whole world with almost 11 million cases, in a span of around six months. It has not only increased the global burden of disease but has heavily dented many social institutions, including education.

    METHODS: This study investigates how the COVID-19 pandemic and subsequent measures of lockdown, quarantine, and social distancing have affected students. We look specifically into the effects on individuals' mental health, that is, the stress and anxiety levels of college and university students using the Zung Self-rating Anxiety Scale (SAS).

    RESULTS: Among 494 respondents, 61% were females, and the majority (77.3%) of the students were in the age group of 19-25 years. Among the respondents, 125 (25.3%), 45 (9.1%) and 34 (6.9%) experienced minimal to moderate, severe, and most extreme levels of anxiety, respectively. The variables of gender, age and year of study were significant at the 0.25 level by univariate analyses. Nevertheless, the ordinal regression indicates that only gender was significant. The odds of a female student being more anxious are higher compared to a male student (OR = 1.779, 95% CI [1.202-2.634], P = 0.004). The most prominent stressors attained from the qualitative feedback from the Pakistani students are associated with online teaching, concerns about their academic performance and completion of the current semester, uncertainty related to exam dates, and the status of the following semester.

    CONCLUSIONS: This study will add to the existing body of literature on the impacts of the COVID-19 pandemic on the social and psychological health of students. The study outcomes will provide basic data for further applied and action research and a framework for universities and policy makers in Pakistan and the neighboring countries in the region with the same cultural contexts. Thus, relevant health interventions can be designed for better mental health and educational attainments of students from higher educational institutions. This pathological pandemic may well lead to another pandemic of mental and behavioral illness. All stakeholders should join force regardless of pre-existing differences and inequalities to ensure the well-being of future generations, specifically students from higher educational institutions. The long-lasting impacts and the aftermath of this pandemic will unquestionably need further and future investigations. Keywords: Anxiety, students, mental health, COVID-19, Pakistan.

  4. Sundarasen S, Chinna K, Kamaludin K, Nurunnabi M, Baloch GM, Khoshaim HB, et al.
    Int J Environ Res Public Health, 2020 Aug 27;17(17).
    PMID: 32867024 DOI: 10.3390/ijerph17176206
    The COVID-19 pandemic and the lockdown has taken the world by storm. This study examines its impact on the anxiety level of university students in Malaysia during the peak of the crisis and the pertinent characteristics affecting their anxiety. A cross-sectional online survey, using Zung's self-rating anxiety questionnaire was conducted during the COVID-19 pandemic and lockdown. Out of the 983 respondents, 20.4%, 6.6%, and 2.8% experienced minimal to moderate, marked to severe, and most extreme levels of anxiety. Female gender (OR = 21.456, 95% CI = 1.061, 1.998, p = 0.020), age below 18 years (OR = 4.147, 95% CI = 1.331, 12.918, p = 0.014), age 19 to 25 (OR = 3.398, 95% CI = 1.431, 8.066, p = 0.006), pre-university level of education (OR = 2.882, 95% CI = 1.212, 6.854, p = 0.017), management studies (OR = 2.278, 95% CI = 1.526, 3.399, p < 0.001), and staying alone (OR = 2.208, 95% CI = 1.127, 4.325, p = 0.021) were significantly associated with higher levels of anxiety. The main stressors include financial constraints, remote online teaching and uncertainty about the future with regard to academics and career. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
  5. Baloch GM, Kamaludin K, Chinna K, Sundarasen S, Nurunnabi M, Khoshaim HB, et al.
    PMID: 33673237 DOI: 10.3390/ijerph18041799
    COVID-19 has speedily immersed the globe with 72+ million cases and 1.64 million deaths, in a span of around one year, disturbing and deteriorating almost every sphere of life. This study investigates how students in Pakistan have coped with the COVID-19. Zung's self-rating anxiety scale (SAS) was used for measuring anxiety and the coping strategies were measured on four strategies i.e., seeking social support, humanitarian, acceptance, and mental disengagement. Among 494 respondents, 61% were females and 77.3% of the students were in the age group of 19-25 years. The study findings indicate that approximately 41 percent of students are experiencing some level of anxiety, including 16% with severe to extreme levels. Seeking social support seemed to be the least preferred coping strategy and that female students seek social support, humanitarian, and acceptance coping strategies more than males. Students used both emotion-based and problem-based coping strategies. The variables of gender, age, ethnicity, level and type of study, and living arrangement of the students were associated with usage of coping strategies. Findings showing that students do not prefer to seek social support. The study outcomes will provide basic data for university policies in Pakistan and the other countries with same cultural contexts to design and place better mental health provisions for students.
  6. Nurunnabi M, Hossain SFAH, Chinna K, Sundarasen S, Khoshaim HB, Kamaludin K, et al.
    F1000Res, 2020;9:1115.
    PMID: 33274049 DOI: 10.12688/f1000research.25557.1
    Background: COVID-19 has severely affected university students everywhere in the world. Due to fear of infection, government and local authorities in China immediately closed academic institutions and tried to find survival techniques to cope with market turbulence. COVID-19 was present in China at the end of 2019. However, little attention has been paid by researchers to coping strategies during the COVID-19 pandemic, and few measures were taken to assess the coping strategies of university students, specifically following the closure of their institutions. To address this gap, this study attempted to discover the coping strategies of Chinese students during the COVID-19 pandemic in China. Methods: We conducted an online survey using a semi-structured questionnaire with a simple random sampling technique and received 559 responses. The survey questions captured information about students' lives during the COVID-19 outbreak, actions to control anxiety, and what students care about during the pandemic. The associations between coping strategies used and levels of anxiety were tested using analysis of variance (ANOVA) procedures. SPSS Statistics v27 was used for statistical analysis in this study. Results: The university students reported that coping strategies and survival techniques were required due to high levels of anxiety and psychological pressure during the COVID-19 pandemic. Most of the respondents reported the prompt closure of their academic institutions due to COVID-19. Psychological concerns, such as lack of sleep, emotional support, mental support and social appeal, were also reported. Conclusions: This is one of the very first studies on coping strategies for anxiety in China. The study reveals that university students employ a number of coping strategies in relation to COVID-19, but also suggests a need to strengthen such strategies in this population. However, the study was limited to a small number of provinces in China, which may affect the generalizability of the research.
  7. Khoshaim HB, Al-Sukayt A, Chinna K, Nurunnabi M, Sundarasen S, Kamaludin K, et al.
    Front Psychiatry, 2020;11:579750.
    PMID: 33362601 DOI: 10.3389/fpsyt.2020.579750
    COVID-19 is the worst pandemic of this millennium, and it is considered to be the "public enemy number one." This catastrophe has changed the way we live in the blink of an eye. Not only has it threatened our existence and health status, but the damage associated with it could equally affect our economic, social, and educational systems. The focus of this study was on the anxiety level of university students during the COVID-19 pandemic in Saudi Arabia. The study was conducted between March and June 2020. A questionnaire was administered online, and 400 completed questionnaires were returned. In this study, the Zung self-rating anxiety scale was used to determine the anxiety levels among the respondents. The results indicated that about 35% of the students experienced moderate to extreme levels of anxiety. Anxiety was highly associated with age, sex, and level of education. These findings can enlighten government agencies and policy makers on the importance of making prompt, effective decisions to address students' anxiety during the COVID-19 pandemic. Researchers are encouraged to focus their future studies on how to develop strategies to boost students' resilience and enhance their adaptability skills for similar disasters in the future.
  8. Khoshaim HB, Al-Sukayt A, Chinna K, Nurunnabi M, Sundarasen S, Kamaludin K, et al.
    J Public Health Res, 2020 Nov 17;9(Suppl 1):1898.
    PMID: 33437753 DOI: 10.4081/jphr.2020.1898
    The novel coronavirus is the worst pandemic of this century. Unfortunately, there is no clear solution for how to cope with such an epidemic. This study examines the coping strategies used by university students in the Kingdom of Saudi Arabia. From March to May 2020, a questionnaire was administered and completed by 400 students. This study used the Zung Self-rating Anxiety Scale (SAS) to examine the respondents' level of anxiety. The results indicate that 35% of students experienced some levels of anxiety. Moreover, there was a moderate use of four types of coping strategies: Seek social support, acceptance, mental disengagement, and humanitarian. These findings can guide policymakers on the importance of developing practical guidelines to handle such lethal diseases. Moreover, the results inform the Saudi community what strategies were used to cope so far with the pandemic. Future research is expected to address the validity and appropriateness of these strategies and encourage other approaches.
  9. Chinna K, Sundarasen S, Khoshaim HB, Kamaludin K, Nurunnabi M, Baloch GM, et al.
    PLoS One, 2021;16(8):e0253059.
    PMID: 34343187 DOI: 10.1371/journal.pone.0253059
    The COVID-19 pandemic and the lockdown measures have taken a toll on every level of the society, worldwide. This study examines their psychological impact on university students in Asia. A cross-sectional online survey was conducted between April and May 2020 in Malaysia, Saudi Arabia, Pakistan, Bangladesh, China, India and Indonesia. The Zung's self-rating anxiety scale (SAS) and questions on adaptive and maladaptive coping strategies were used in this study. A total of 3,679 students from the seven countries participated in this study. Overall, 21.9% and 13.7% of the students in this study experienced mild to moderate and severe to extreme levels of anxiety. More than 20% of the students from China and Bangladesh reported severe to extreme level of anxiety compared to below 10% of the students from Indonesia, Malaysia and India. Among the female students, 15.9% experienced severe to extreme level of anxiety compared to 10.6% among the males. Females from Bangladesh, China, Malaysia, Pakistan and Saudi Arabia experienced significantly higher levels of anxiety compared to their male counterparts. Acceptance was the most used and Seeking Social Support was the least used coping strategies among the students. There were significant differences in the usage of the four strategies by countries. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
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