TITLE: Impact of covid19 on mental health

of Ziauddin University students in Karachi.

Across-Sectional Study:

ASSIGNMENT: NURSING RESEARCH

NAME OF STUDENTS

 Ali Haider
 Arshad Ali Khan
 Bilal Ahmed
 Fawad Khan
 Farzana Sher Hakim
 Haseeba Alam
 Javed Iqbal
 Karim Khan
 Khalida

BSCN YEAR 4 SEMESTER 7th

NAME OF SUPERVISOR

 MISS: SAHAR LALANI

 MISS: MISHAL

DATE: 28-APRIL-2023

pg. 1
Title:

Impact of covid19 on mental health of Ziauddin

University students in Karachi.

Across-Sectional Study:

Introduction:

Background of the study:

The COVID-19 pandemic has not only posed a threat to physical health but has also

significantly impacted mental health globally. University students, in particular, have

faced unique challenges due to disruptions in their academic, social, and personal

lives. Ziauddin University in Karachi, Pakistan, has also been affected by the

pandemic, and it is crucial to understand the impact on the mental health of its

students. This research proposal aims to investigate the impact of COVID-19 on the

mental health of Ziauddin University students, using a cross-sectional study design.

Conceptual definition:

COVID-19, also known as coronavirus disease 2019, is a highly infectious disease

caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The

virus was first identified in Wuhan, China, in December 2019 and has since spread

rapidly across the globe, leading to a global pandemic.

pg. 2
The virus spreads mainly through respiratory droplets when an infected person talks,

coughs, or sneezes. It can also spread by touching a surface contaminated with the

virus and then touching one's mouth, nose, or eyes. The symptoms of COVID-19 can

range from mild to severe and include fever, cough, shortness of breath, fatigue, body

aches, loss of smell or taste, sore throat, and diarrhea. Some people may be

asymptomatic, meaning they show no symptoms at all but can still spread the virus to

others.

COVID-19 has had a significant impact on the world, both in terms of health and

economy. The pandemic has resulted in millions of deaths and hospitalizations

worldwide, and has caused widespread fear, anxiety, and uncertainty. It has also led to

lockdowns and social distancing measures, resulting in job losses, business closures,

and economic hardship.

Efforts to combat the virus have included developing vaccines, implementing testing

and contact tracing measures, and promoting public health guidelines such as wearing

masks, washing hands frequently, and maintaining physical distance from others.

Vaccines have been shown to be effective in preventing severe illness and death from

COVID-19, and widespread vaccination is considered one of the most important tools

in controlling the pandemic.

The COVID-19 pandemic has highlighted the importance of preparedness and

response in the face of global health crises. It has also highlighted disparities in access

to healthcare and socioeconomic factors that can contribute to the spread and severity

of the disease. Ongoing research and innovation in the fields of public health,

virology, and vaccine development will continue to be essential in the ongoing fight

against COVID-19 and future pandemics.

pg. 3
Operational Definition:

The operational definition of the impact of COVID-19 on Ziauddin University

students refers to the various psychological and emotional effects that the pandemic

has had on the student population at Ziauddin University.

Psychological and emotional impacts of COVID-19 on Ziauddin University students:

Anxiety and Stress: The uncertainty surrounding the pandemic has led to increased

levels of anxiety and stress among students. The fear of contracting the virus or

infecting others, coupled with the disruption to academic and social activities, has led

to heightened levels of anxiety and stress.

Depression and Isolation: The isolation resulting from social distancing and

quarantine measures has had a significant impact on students' mental health. Many

students have reported feelings of loneliness, depression, and hopelessness as a result

of the lack of social interaction and support.

Academic Pressure: The sudden shift to remote learning has created significant

challenges for students, leading to added academic pressure. Many students have

reported feeling overwhelmed with the increased workload, lack of face-to-face

interaction with professors, and difficulties in adapting to the online learning

environment.

pg. 4
Financial Stress: The economic impact of the pandemic has also taken a toll on

students, particularly those from lower-income families. Many students have reported

financial stress, including difficulties in paying tuition fees, affording basic

necessities, and losing part-time jobs that they relied on to support themselves.

Fear and Uncertainty about the Future: The pandemic has created significant

uncertainty about the future, particularly regarding job prospects and post-graduation

plans. This uncertainty has led to increased levels of fear and stress among students,

particularly those in their final year of study.

Literature Review:

The COVID-19 pandemic and its associated infection control measures have

disrupted the lives of higher education students worldwide. The changes have

deprived students of in-person counselling services and social support, increasing

their risk of developing mental health problems. The objective of a recent review was

to evaluate the prevalence of depressive symptoms, anxiety symptoms, and sleep

disturbances among higher education students during the pandemic. The study

involved a systematic search of English and Chinese databases conducted until

January 1st, 2021. Eighty-nine studies (n=1,441,828) were included in the analysis,

and the results showed that the pooled prevalence of depressive symptoms, anxiety

symptoms, and sleep disturbances was 34%, 32%, and 33%, respectively. The

prevalence varied based on factors such as geography, diagnostic criteria, education

level, living arrangements, financial situation, gender, and undergraduate year of

pg. 5
study. The review indicated that mental health screening and intervention should be a

top priority for universities and colleges during the pandemic.

Another study investigated the mental health of Swiss undergraduate students before

and during the pandemic. The longitudinal data collected since 2018 showed that

interaction and co-studying networks had become sparser, and more students were

studying alone. Additionally, the students’ levels of stress, anxiety, loneliness, and

depressive symptoms had worsened, compared to measures before the crisis. The

study identified COVID-19 specific worries, lack of interaction and emotional

support, isolation in social networks, and physical isolation as factors associated with

negative mental health trajectories. Female students were found to have worse mental

health trajectories when controlling for different levels of social integration and

COVID-19 related stressors. The study suggested that universities and researchers

should consider social contacts in students' mental health when combining on-site

teaching with online courses.

A cross-sectional study was conducted to explore the impact of COVID-19 on the

mental health and wellbeing of Bangladeshi students. The study involved 505 college

and university students, and the data were collected using an online questionnaire,

including DASS 21 and IES. The results showed that 28.5% of the respondents had

stress, 33.3% anxiety, and 46.92% depression, ranging from mild to extremely severe,

according to DASS 21. Additionally, 69.31% had event-specific distress, ranging

from mild to severe, according to IES. The study found that perceiving physical

symptoms as COVID-19 was significantly associated with stress, anxiety, depression,

pg. 6
and post-traumatic symptoms. Fear of infection, financial uncertainty, inadequate

food supply, absence of physical exercise, and limited or no recreational activity had a

significant association with stress, anxiety, depression, and post-traumatic symptoms.

The stresses and restrictions associated with the COVID-19 pandemic have put

university students at greater risk of developing mental health issues, which may

significantly impair their academic success, social interactions, and future career and

personal opportunities. A survey conducted in one University in the North of England

found high levels of anxiety and depression, with more than 50% of the respondents

experiencing levels above the clinical cut-offs. The survey suggested relatively low

levels of resilience among the students, with females scoring significantly higher than

males. The study indicated that mental health screening and intervention should be an

essential aspect of university support services during the pandemic.

Literature GAP: Impact of covid19 on mental health of Ziauddin University

students in Karachi. Across-Sectional Study:

Methodology:

Study Design: A cross-sectional study design will be used to collect data at a specific

point in time to determine the prevalence of mental health issues among Ziauddin

University students during the COVID-19 pandemic.

Sample Method:

Convenience sampling technique will be used to select participants who are currently

enrolled as students at Ziauddin University in Karachi, Pakistan.

pg. 7
Sample Size:

The target sample size for this study is 400 Ziauddin University students.

Setting:

The study will be conducted at Ziauddin University, located in Karachi, Pakistan.

Sampling Techniques:

Convenient sampling will be used to select participants based on their availability and

willingness to participate in the study.

Sample Selection (Inclusion and Exclusion Criteria):

Participants who are currently enrolled as students at Ziauddin University and are

willing to provide informed consent will be included in the study. Participants who

are not currently enrolled as students at Ziauddin University or do not provide

informed consent will be excluded from the study.

Data Collection Procedure:

Data will be collected using a structured questionnaire that includes validated scales

to assess mental health issues such as stress, anxiety, and depression. The

questionnaire will be administered online via a secure platform to ensure

confidentiality and privacy.

Data Analysis Procedure:

Descriptive and inferential statistical analysis will be conducted using appropriate

statistical tests such as chi-square test, t-test, and regression analysis to analyze the

pg. 8
data obtained from the questionnaire responses. Statistical software such as SPSS will

be used for data analysis.

Ethical Considerations:

Ethical approval will be obtained from the Institutional Review Board (IRB) of

Ziauddin University, Karachi, Pakistan, before the start of the study. Informed

consent will be obtained from all participants, and their confidentiality and privacy

will be protected throughout the study.

Data Collection Procedure:

Data will be collected using a structured questionnaire that includes validated scales

to assess mental health issues such as stress, anxiety, and depression. The

questionnaire will be administered online via a secure platform to ensure

confidentiality and privacy.

Problem Identification:

The COVID-19 pandemic has resulted in significant disruptions to the lives of

university students, including changes in academic structure, social isolation, and

increased stress levels. The problem identified is the potential negative impact of the

pandemic on the mental health of Ziauddin University students in Karachi. The

research question is: "What is the impact of COVID-19 on the mental health of

Ziauddin University students in Karachi?"

pg. 9
 Research questions:

DASS-21 scale
QUESTIONS Strongly Disagree Strongly Not
disagree agree applicable
1. How often have you felt nervous or 1. 2. 3. 4.
anxious during the past week due to COVID-
19?
2. How often have you felt hopeless or 1. 2. 3. 4.
discouraged during the past week due to
COVID-19?
3. How often have you felt restless or fidgety 1. 2. 3. 4.
during the past week due to COVID-19?
4. How often have you felt that everything 1. 2. 3. 4.
was an effort during the past week due to
COVID-19?
5. How often have you felt sad or depressed 1. 2. 3. 4.
during the past week due to COVID-19?
6. How often have you felt that you were 1. 2. 3. 4.
unable to cope during the past week due to
COVID-19?
7. How often have you felt that you were no 1. 2. 3. 4.
longer enjoying the things you used to enjoy
during the past week due to COVID-19?

8. How often have you felt that you were 1. 2. 3. 4.
getting agitated during the past week due to
COVID-19?

9. How often have you felt that you were 1. 2. 3. 4.
losing control during the past week due to
COVID-19?

10. How often have you felt that you were 1. 2. 3. 4.
close to panic during the past week due to
COVID-19?

Here are ten questions you could use for a research proposal on the

impact of covid-19 on the mental health of ZIAUDDIN

UNIVERSITY students using the DASS-21 scale:

pg. 10
Research objective:

The aim of this study is to investigate the impact of the COVID-19 pandemic on

mental health and wellbeing over time. Specifically, we seek to:

1. Identify the prevalence of anxiety, depression, and other mental health issues

before, during, and after the pandemic in a sample of individuals.

2. Examine the impact of varying levels of pandemic restrictions and policies on

mental health outcomes, including anxiety, depression, and stress.

3. Assess the role of personal factors such as demographics, social support, coping

strategies, and resilience in mediating the impact of the pandemic on mental health.

4. Explore potential changes in mental health service utilization and attitudes towards

mental health treatment as a result of the pandemic.

pg. 11
References

1. Elmer, T., Mepham, K., & Stadtfeld, C. (2020). Students under lockdown:
Comparisons of students' social networks and mental health before and during the
COVID-19 crisis in Switzerland. PloS one, 15(7), e0236337.
https://doi.org/10.1371/journal.pone.0236337
2. Wang, X., Hegde, S., Son, C., Keller, B., Smith, A., & Sasangohar, F. (2020).
Investigating Mental Health of US College Students During the COVID-19
Pandemic: Cross-Sectional Survey Study. Journal of medical Internet research, 22(9),
e22817. https://doi.org/10.2196/22817
3. Zhang, Y., Zhang, H., Ma, X., & Di, Q. (2020). Mental Health Problems during the
COVID-19 Pandemics and the Mitigation Effects of Exercise: A Longitudinal Study
of College Students in China. International journal of environmental research and
public health, 17(10), 3722. https://doi.org/10.3390/ijerph17103722
4. Deng, J., Zhou, F., Hou, W., Silver, Z., Wong, C. Y., Chang, O., Drakos, A., Zuo, Q.
K., & Huang, E. (2021). The prevalence of depressive symptoms, anxiety symptoms
and sleep disturbance in higher education students during the COVID-19 pandemic:
A systematic review and meta-analysis. Psychiatry research, 301, 113863.
https://doi.org/10.1016/j.psychres.2021.113863
5. Khan, A. H., Sultana, M. S., Hossain, S., Hasan, M. T., Ahmed, H. U., & Sikder, M.
T. (2020). The impact of COVID-19 pandemic on mental health & wellbeing among
home-quarantined Bangladeshi students: A cross-sectional pilot study. Journal of
affective disorders, 277, 121–128. https://doi.org/10.1016/j.jad.2020.07.135
6. Chen, T., & Lucock, M. (2022). The mental health of university students during the
COVID-19 pandemic: An online survey in the UK. PloS one, 17(1), e0262562.
https://doi.org/10.1371/journal.pone.0262562
7. Lyons, Z., Wilcox, H., Leung, L., & Dearsley, O. (2020). COVID-19 and the mental
well-being of Australian medical students: impact, concerns and coping strategies
used. Australasian psychiatry : bulletin of Royal Australian and New Zealand College
of Psychiatrists, 28(6), 649–652. https://doi.org/10.1177/1039856220947945
8. Koelen, J. A., Mansueto, A. C., Finnemann, A., de Koning, L., van der Heijde, C. M.,
Vonk, P., Wolters, N. E., Klein, A., Epskamp, S., & Wiers, R. W. (2022). COVID-19
and mental health among at-risk university students: A prospective study into risk and
protective factors. International journal of methods in psychiatric research, 31(1),
e1901. https://doi.org/10.1002/mpr.1901
9. Kecojevic, A., Basch, C. H., Sullivan, M., & Davi, N. K. (2020). The impact of the
COVID-19 epidemic on mental health of undergraduate students in New Jersey,
cross-sectional study. PloS one, 15(9), e0239696.
https://doi.org/10.1371/journal.pone.0239696
10. Tang, W., Hu, T., Hu, B., Jin, C., Wang, G., Xie, C., Chen, S., & Xu, J. (2020).
Prevalence and correlates of PTSD and depressive symptoms one month after the
outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese
university students. Journal of affective disorders, 274, 1–7.
https://doi.org/10.1016/j.jad.2020.05.009

pg. 12