Abstract

College is a time of increased stress and anxiety. The current changes in attendance and methods of instruction due to COVID-19 have demonstrated even higher levels of stress, anxiety, and mental health issues. Tailoring interventions to the specific needs of a campus community has been proposed as an appropriate means to the current crisis. This study identifies the mental health needs of students at a rural college as they pertain to the effects of the pandemic. Questionnaires collected data from college students (N=33) at Athens State University, a rural university in north Alabama, to understand the effects of the COVID-19 pandemic on their mental health and well-being. Data obtained from the 58-question instrument were analyzed through quantitative and qualitative methods. Results Data revealed that 33/33 (100%) students indicated higher levels of anxiety and stress due to the outbreak. Stressors contributing to the increased anxiety, stress, and depressive symptoms included anticipated duration of the pandemic (31/33, 93.9%), stress of current financial situation (24/33, 72.7%), uncertainty of the future (31/33, 93.9%), decreased social interactions and sense of community with peers (29/33, 87.9%), concerns about the health of loved ones and self (33/33, 100%). Students described a high level of comfort in participation in a flexible learning environment (31/33, 93.9%). Students identified various coping mechanisms. The results of our study underscore the need for directed mental health interventions for college students and flexible platforms of study. Consideration of developing a flexible learning environment should be included as part of directed mental health interventions.

Keywords: mental health, college students, suicide prevention, attitudes and behaviors, HyFlex

Introduction

Mental health well-being is an important factor contributing to the success of college students. (Eisenberg, Golberstein, & Hunt, 2009; Luca, Franklin, Yueqi, Johnson, & Brownson, 2016) The Spring 2019 reports from the National College Health Assessment (NCHA) indicate that 55.8% of college students felt hopeless, 87.7% felt overwhelmed, 70.8% felt very sad, and 13.3% reported seriously considering suicide during the 12 months prior to being surveyed (American College Health Association, 2019). Additionally, when asked about suicidal ideation (SI) in the preceding 12 months, those reporting SI had a lower average cumulative GPA than those who did not have SI during the same time period (Luca, Franklin, Yueqi, Johnson, & Brownson, 2016). The results of these studies revealed just how much mental health well-being factors into the success of college students. These results validated the results from the 2012 National Alliance on Mental Illness (NAMI) survey that indicated as many as 73% of these college students will experience crisis while attending college. 64% of the survey respondents who were no longer attending college stated the reason for departure was mental health related (Gruttadaro & Crudo, 2012), with anxiety being a common theme with attrition (Eisenberg, Golberstein, & Hunt, 2009), as well as poor academic performance. (Kitzrow, 2003).

Small, rural college campuses can pose different challenges to students than larger universities. Small class sizes and a more intimate learning environment are often cited as reasons students choose to attend small colleges. These same benefits of a small college can also contribute to added student stress. Students who are working while going to college may need to drive distances to and from their job resulting in increased stress levels. (Rasmussen, 2000; Calloway, Kelly, & Ward-Smith, 2012; Antoun, Edwards, Sweeting, & Ding, 2017; Nelson, Misra, Sype, & Mackie, 2016) Additionally, students may not have as many opportunities for extracurricular activities and may be reliant on the social interactions they are able to establish. (Graham, Hurtado, & Gonyea, 2018; Elliott & Healy, 2001; Calloway, Kelly, and Ward-Smith, 2012)

Many college students learn that campus life comes with new adjustments and, for some, new responsibilities which may create an increase in stress. A survey study of college students noted that up to 80% of students report responsibility for paying some or all of their college expenses (Citi, 2013). Stress due to financial concerns has been associated with increased anxiety in addition to physical and mental health impairment. (Jones, Park, & Lefevor, 2018 Hodgson & Simoni, 1995). 65.3% of matriculating college freshmen reported concern over successfully completing their degree due to financial reasons (Jones, Park, & Lefevor, 2018). Kitzrow et al. noted an increase in student mental health concerns concomitant with the increasing cost of education. The look and feel of the student population is changing as Nontraditional Adult Learners (NALs) are increasing among colleges. Up to 75% of students currently identify with this growing demographic (Bodfish, 2002). This is especially true at Athens State University, where a large number of students work full-time, have families, and juggle other responsibilities. Events that impact their financial resources may also lead to increased anxiety over housing, food, and meeting household financial obligations.

The COVID-19 pandemic has impacted college students in ways that directly affect these identified causes of stress and anxiety. Early in the course of the COVID-19 pandemic, college presidents reported in two surveys their increasing concern over student mental health and the disproportionate impact on students from low-income backgrounds. (Lederman, 2020) Federal Work-Study stipends on which many students rely for income were stopped for students who were not allowed to return to campus. (Gomez, 2020) Unemployment in the United States rose more over the course of three months early in the COVID-19 pandemic than it had during any three-month period in the history of the country. (Kochhar, 2020) Aucejo et al. (2020) noted their survey results indicated 40% of college students they surveyed had lost a job, internship, or offer due to the COVID-19 pandemic. The Pew Research Center (2020) noted 25% of workers were employed in the industries most likely to be impacted by the COVID-19 pandemic and that about half of workers between ages 16 to 24 work in those sectors. (Kochhar & Barroso, 2020) The bureau of labor statistics noted that part-time workers were twice as likely as full-time workers to be unemployed and that service occupations were impacted most due to the COVID-19 pandemic. (BLS, 2021)

The implementation of social distancing coupled with mandatory lockdowns of certain sectors of the population induces feelings of isolation and loneliness. Students who were used to traveling freely and communicating with others when they wanted were forced into a situation of social isolation and restrictions that have been demonstrated to be linked with feelings of frustration and uncertainty. (Serafini et al., 2020) COVID-19 revealed how many college students were grossly unprepared emotionally for separation from friends and family to this degree. Serafini et al. (2020) demonstrated how frustration and distress are directly related to quarantine, reduced physical and social contact with others, and loss of usual habits. Students were accustomed to their established social networking activities and daily routines. (Jeong et al., 2016) The newly imposed limitations on free movement due to the pandemic could contribute to a sense of pervasive loneliness and hopelessness, which are significantly associated with increased depression and suicidal behavior. (Cava et al., 2005)

The COVID-19 pandemic forced institutions to reconsider how to serve students in an ever-changing environment. In January 2020, students, instructors, and institutions began the academic term with a “business as usual” mindset. Yet, by March 2020, the rapid spread of the Coronavirus forced institutions to shut down. COVID-19 resulted in the closure of schools all across the world where over 1.2 billion children (K-12) and in higher education were out of the classroom (Whiting, 2020). This resulted in institutions being shut down to in-person learning, with a quick shift to online education. In higher education, the impact on students came more into focus, highlighting education disruptions due to factors such as economic issues, childcare, and mental health. Moving online allowed for continued studies as the world continued to figure out how to adapt with various school reopening models. In order to help maintain student success and simultaneously strengthen Athens States’ ability to combat unforeseen circumstances, new methods of instruction were adopted and implemented like HyFlex to address the disruptions.

Dhawan (2020) describes HyFlex as a delivery where “each class session and learning activity is offered in-person, synchronously online, and asynchronously online. Students can decide how to participate.” In Fall 2020, several faculty at Athens State were trained and piloted classes using HyFlex as the university began to reopen its operations. The pilot offered lessons learned as instructors aimed to provide flexibility for all students in an uncertain world by implementing the HyFlex model.

This allowed students to be in an active learning community. According to Tinto’s SAM and SIM model of student retention, social integration (friendships, connections, interactions) is a key element in a student’s decision to remain in school (Manyanga et al., 2017, p. 33). It has been shown that community is directly tied to an adult student’s emotions (Hara & Kling, 2000). When participating in an online course, positive emotions can lead to reduced anxiety as students are integrated into such a community.

Harrell and Bower (2011) demonstrated that certain characteristics exist in students that tend to persist in online courses. With the uncertainty of what the pandemic would mandate in terms of traditional courses, the university wanted to create or utilize a system that would allow for students to change modality based on external circumstances. Therefore, if the students originally signed up for a distance learning course but a recession in the severity of the pandemic allowed for more traditional interactions, the students needing the traditional coursework could switch modalities and ultimately settle in the mode of course in which they felt most comfortable. Dealing with changing factors such as having children at home in quarantine or having to travel for the death of a loved one was not an issue with HyFlex, as it allowed for flexibility depending upon the circumstances.

Methods

Study Population and Setting

The current study was conducted at Athens State University, a rural, public, two-year upper-level university with an undergraduate and graduate enrollment of 3,621. The study was approved by the Athens State University Institutional Review Board. The cross-sectional study was conducted through an online survey over a span of three weeks in October 2020.

Recruitment Methods

After receiving institutional board approval, students were recruited through verbal announcements in courses throughout the college. No incentives were given to students who elected to participate in the study. Each participant was only allowed to participate in the survey one time. Participation in the survey was voluntary.

Measures

Data were collected via an online survey through Assessment Management Evaluation Entry (AMEE), Athens State University’s in-house survey system. Participants were asked their age, gender, sexual orientation, and religious affiliation. Eleven questions on the survey were previously used by the Healthy Minds Study (HMS) to evaluate concerns of students related to COVID-19. This portion of the survey containing five-point Likert-type response options ranging from “Not Concerned at All (1)” to “Extremely Concerned (5)” was used to ask students about their concerns related to COVID-19 over the previous two weeks. They were additionally asked on a five-point Likert type response options ranging from “A lot more stressful (1)” to “A lot less stressful (5)” their financial situation and the impact of COVID-19 on their finances. The next portion of the survey consisted of twenty questions on 5-point Likert type scales ranging from “Completely disagree (1)” to “Completely agree (5)” related to their perceptions of mental illness, mental health support services at the university, and personal needs related to mental health. Finally, students were informed of the HyFlex flexible learning environment offered to students at the university and were asked questions related to their comfort level of participation in HyFlex, stress related to the HyFlex model of learning, and interaction/social experience with the HyFlex platform.

Data Analysis

Statistical analyses were performed using the Statistical Package for Social Sciences Version 16.0 (SPSS Inc., Chicago, IL, USA). Values were expressed as mean±SD or as percentages.

Results

In total, 33 undergraduate students from Athens State University participated in the survey during the Fall 2020 semester of study. Most respondents were female (81.8%), and ages ranged from 20 to 64 years (M = 32, SD = 2.18). Reported religions among respondents were Agnostic (6%), Catholic (6%), None (15%), Protestant (70%), and Self-Identify (3%). Heterosexual students (91%) represented the largest demographic of sexual orientation, followed by gay (3%), bisexual (3%), and questioning (3%). See Table 1.

Respondents noted that duration of the COVID-19 pandemic (31/33, 93.9%), additional spread of infection (33/33, 100%), and additional deaths as a result of COVID-19 (33/33, 100%) were causing them concern. They further noted a personal sense of safety and security (28/33, 84.8%), personally contracting COVID-19 (30/33, 90.9%), and loved ones contracting (33/33, 100%) or dying from (32/33, 97%) COVID-19 were weighing factors for anxiety and stress. Additionally, not being able to spend time with loved ones (31/33, 93.9%), uncertainty of the future (31/33, 93.9%), and missing milestones at school (29/33, 87.9%) were also noted to be stress and anxiety-inducing issues.

Students admitted to feeling isolated from campus (20/33, 60.6%) and that the campus environment does not present a negative impact on students (28/33, 84.8%). In fact, students felt the campus climate encourages free and open discussion about mental and emotional health (31/33, 93.9%), students are working to promote mental health on campus (30/33, 90.9%), the administration is listening to the concerns of students when it comes to health and wellness (30/33, 90.9%), and there is a good support system on campus for students going through difficult times (31/33, 93.9%).

The opportunity to participate in the HyFlex learning environment was positively received by respondents. Students noted comfort in participating in a reduced size HyFlex course (31/33, 93.9%) and perceived the level of social experience and interaction through the HyFlex platform to be positive (25/33, 75.8%). Additionally, stress levels with taking a course through the flexible HyFlex model were not considered to be an issue for students (17/33, 51.5%).

Discussion

HyFlex learning was originally developed by Dr. Brian Beatty (Beatty, 2010). Athens began the HyFlex pilot with faculty training in late July of 2020. Beatty’s framework of HyFlex features four principles:

1. HyFlex is the ability for students to have choice
2. Equivalency of all learning activities, regardless of format
3. Reusability of all activities, lectures, and multimedia in the class for all students
4. Accessibility of all students to have the technology skills to access all methods of delivery (Abdelmalak & Parra, 2016).

The faculty members were at varying stages of familiarity with the HyFlex content and the technology being used to make the HyFlex teaching work. With classes being scheduled to start approximately two weeks after the training session, it was determined that active learning pedagogies would be encouraged in the courses to foster a sense of engagement and to create an online learning community.

The focus on active learning also led to a wide spectrum of active and interactive elements among the courses. Students across all delivery modalities achieved the same learning outcomes. Student engagement through active learning increases student learning outcomes in different instructional settings (Khan et al., 2017). To engage students across multiple modalities, some instructors chunked instruction to allow for an opportunity for the instructor to share knowledge and an opportunity for the students to engage in collaborative activities. Including interactive elements among students in different methods such as using group work, discussions, and student presentations increased the views of HyFlex modalities throughout both faculty and students. Additional forms of engagement tested included Live Polling, where both students attending class and those joining online could participate. The students reached out using an instant message feature outside of class to ask questions and give feedback about personalized videos. This lent itself to better community and engagement so that students did not feel isolated.

Conclusion

Overall, most of the instructors involved with the HyFlex experience felt that students had more access, felt comfortable across formats, and viewed the extra setup as worthwhile. According to Beatty, the major benefits to faculty included the ability to serve more students with the same resources, skill development, and expertise in online teaching without the sacrifice of classroom instruction and provide alternatives for classroom instruction for conflicts (2019). Faculty members not involved in the pilot sat in on both the traditional section and the online synchronous sections of the HyFlex classes and were able to convert their own courses to teach in this mode and to accommodate students in a variety of formats.

References

Abdelmalak, M. M., & Parra, J. L. (2016). Expanding Learning Opportunities for Graduate Students with HyFlex Course Design. International Journal of Online Pedagogy and Course Design (IJOPCD), 6(4), 19-37. http://doi.org/10.4018/IJOPCD.2016100102

American College Health Association. (2019). College Health Association-National College Health Assessment (ACHA-NCHA-II) Reference Group Data Report – Spring 2019.

Antoun, M., Edwards, K. M., Sweeting, J., & Ding, D. (2017). The acute physiological stress response to driving: A systematic review. Plos One, 12(10). https://doi.org/10.1371/journal.pone.0185517

Archuleta, K. L., Dale, A., & Spann, S. M. (2013). College students and financial distress: exploring debt, financial satisfaction, and financial anxiety. Journal of Financial Counseling and Planning, 24(2), 50–62.

Aucejo, E. M., French, J., Ugalde Araya, M. P., & Zafar, B. (2020). The impact of COVID-19 on student experiences and EXPECTATIONS: Evidence from a survey. Journal of Public Economics, 191, 104271. https://doi.org/10.1016/j.jpubeco.2020.104271

Beatty, B. (2010). Hybrid courses with flexible participation—the HyFlex design. ms, San Francisco.

Bodfish, S. E. (September 2002). 2001-2002 National enrollment management survey executive summary. Noel-Levitz. https://www.noellevitz.com/NR/rdonlyres/E63D7F22-64DF-4FF0-B685-E96F9E921FB4/0/2002_NEMS.pdf

Calloway, S. J., Kelly, P., & Ward-Smith, P. (2012). Stressors and barriers to help seeking for psychological distress among students attending a rural university. Journal of Rural Mental Health, 36(1), 3–10. https://doi.org/10.1037/h0094774

Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 112934. https://doi.org/10.1016/j.psychres.2020.112934

Cava, M. A., Fay, K. E., Beanlands, H. J., McCay, E. A., & Wignall, R. (2005). The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing, 22(5), 398–406. https://doi.org/10.1111/j.0737-1209.2005.220504.x

Citi. (2013, August 7). New Citi/Seventeen Survey: College Students Take Control of Their Financial Futures. Citigroup. http://www.citigroup.com/citi/news/2013/130807a.htm

Dhawan, S. (2020). Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems, 49(1), 5–22. https://doi.org/10.1177/0047239520934018

Eisenberg, D., Golberstein, E., & Hunt, J. (2009a). Mental health and academic success in college. B.E. Journal of Economic Analysis & Policy, 9(1).

Elliott, K. M., & Healy, M. A. (2001). Key Factors Influencing Student Satisfaction Related to Recruitment and Retention. Journal of Marketing for Higher Education, 10(4), 1–11. https://doi.org/10.1300/j050v10n04_01

Gomez, B. (2020, August 24). Over a Half-million students rely on DISAPPEARING work-study jobs. here are options to make up lost income. CNBC. https://www.cnbc.com/2020/08/24/over-a-half-million-students-rely-on-vanishing-work-study-jobs.html

Graham, P. A., Hurtado, S. S., & Gonyea, R. M. (2018). The Benefits of Living on Campus: Do Residence Halls Provide Distinctive Environments of Engagement? Journal of Student Affairs Research and Practice, 55(3), 255–269. https://doi.org/10.1080/19496591.2018.1474752

Gruttadaro, Darcy and Crudo, Dana. “College Students Speak: A Survey Report on Mental Health.” National Alliance on Mental Health. (2012).

Hara, N., & Kling, R. (2000). Students’ distress with a web-based distance education course. Information, Communication and Society, 3(4), 557-579.

Harrell, I. L., & Bower, B. L. (2011). Student characteristics that predict persistence in community college online courses. American Journal of Distance Education, 25(3), 178–191. https://doi.org/10.1080/08923647.2011.590107

Hodgson, C. S., & Simoni, J. M. (1995). Graduate student academic and psychological functioning. Journal of College Student Development, 36, 244–253

Jeong, H., Yim, H. W., Song, Y.-J., Ki, M., Min, J.-A., Cho, J., & Chae, J.-H. (2016). Mental health status of people isolated due to Middle East respiratory syndrome. Epidemiology and Health, 38. https://doi.org/10.4178/epih.e2016048

Jones, P. J., Park, S. Y., & Lefevor, G. T. (2018). Contemporary College Student Anxiety: The Role of Academic Distress, Financial Stress, and Support. Journal of College Counseling, 21(3), 252-264. https://doi.org/10.1002/jocc.12107

Khan, A., Egbue, O., Palkie, B., & Madden, J. (2017). Active learning: Engaging students to maximize learning in an online course. Electronic Journal of E-Learning, 15(2), pp107-115.

Kitzrow, M. A. (2003). The mental health needs of today’s college students: Challenges and recommendations. NASPA Journal, 41(1). https://doi.org/10.2202/0027-6014.1310

Kochhar, R. (2020, August 26). Unemployment rose higher in three months of COVID-19 than it did in two years of the Great Recession. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/06/11/unemployment-rose-higher-in-three-months-of-COVID-19-than-it-did-in-two-years-of-the-great-recession/.

Kochhar, R., & Barroso, A. (2020, August 26). Young workers likely to be hard hit as COVID-19 strikes a blow to restaurants and other service sector jobs. Pew Research Center. https://www.pewresearch.org/fact-tank/2020/03/27/young-workers-likely-to-be-hard-hit-as-COVID-19-strikes-a-blow-to-restaurants-and-other-service-sector-jobs/.

Lederman, D. (2020, April 27). Low-Income Students Top Presidents’ COVID-19 Worry List. Inside Higher Ed. https://www.insidehighered.com/news/survey/presidents-biggest-COVID-19-worries-low-income-students-and-colleges-financial-strain.

Luca, S. M. D., Franklin, C., Yueqi, Y., Johnson, S., & Brownson, C. (2016). The Relationship Between Suicide Ideation, Behavioral Health, and College Academic Performance. Community Mental Health Journal, 52(5), 534–540. https://doi.org/10.1007/s10597-016-9987-4

Manyanga, F., Sithole, A., & Hanson, S. M. (2017). Comparison of Student Retention Models in Undergraduate Education from the Past Eight Decades. Journal of Applied Learning in Higher Education, 7, 30–42.

Nelson, D., Misra, K., Sype, G. E., & Mackie, W. (2016). An analysis of the relationship between distance from campus and gpa of commuter students. Journal of International Education Research (JIER), 12(1), 37–46. https://doi.org/10.19030/jier.v12i1.9565

Rasmussen, C. (2000). Driving-Induced Stress in Urban College Students. Perceptual and Motor Skills, 90(2), 437. https://doi.org/10.2466/pms.90.2.437-443

Serafini, G., Parmigiani, B., Amerio, A., Aguglia, A., Sher, L., & Amore, M. (2020). The psychological impact of COVID-19 on the mental health in the general population. QJM: An International Journal of Medicine, 113(8), 531–537. https://doi.org/10.1093/qjmed/hcaa201

U.S. Bureau of Labor Statistics. (2021, August 10). Supplemental data measuring the effects of the coronavirus (COVID-19) pandemic on the labor market. U.S. Bureau of Labor Statistics. https://www.bls.gov/cps/effects-of-the-coronavirus-COVID-19-pandemic.htm.

Whiting, K. (2020, November 25). Is this what higher education will look like in 5 years? World Economic Forum. https://www.weforum.org/agenda/2020/11/higher-education-online-change-cost-COVID-19/.