**1. Introduction**

By and large, college students generally experience several challenges, including starting new relationships, new life experiences, often new living situations, often an exploration of their sexual identities, usually academic pressures, need for time management, and sometimes balancing study, work, and personal life [1]. A study of college students investigating the psychological correlates found that the top concerns among this subgroup include pressure to succeed, educational performance, and post-college graduation plans [2,3]. These challenges make these students vulnerable to distress and associated negative sequelae such as depression, anxiety, insomnia, suicidal ideation, and adoption of maladaptive behaviors [1–3].

Mental health issues are alarmingly high among college students, particularly in the United States, with every eight in ten students experiencing frequent stress episodes in

**Citation:** Batra, K.; Sharma, M.; Batra, R.; Singh, T.P.; Schvaneveldt, N. Assessing the Psychological Impact of COVID-19 among College Students: An Evidence of 15 Countries. *Healthcare* **2021**, *9*, 222. https:// doi.org/10.3390/healthcare9020222

Academic Editor: Alyx Taylor

Received: 27 January 2021 Accepted: 13 February 2021 Published: 17 February 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

2019 [4]. An eight-country study of 13,984 first-year college students under the World Health Organization's (WHO) World Mental Health Surveys found that the lifetime and annual prevalence of suicidal ideation in this group was 32.7% and 17.2%, respectively, which correspond to the high distress levels in the students' subgroup [5]. The likelihood of suicidal ideation increased twice following one or two traumatic events [1]. Among predictors of major depressive disorders, prior suicide plans/attempts, a history of childhood traumatic or stressful events, and family history contributed to college students' mental adversities [6]. These data are especially relevant in the context of U.S. college students, and the proportion of affected students may vary from country to country. Nonetheless, the mental health issues of college students emerge as a critical public health concern.

Mental health problems adversely affect numerous aspects of life. For college students, academic performance is the first to be affected. A Belgian study found that mental health problems have reduced college students' grade point average (GPA) by 0.2 to 0.3 points [7]. Depressive disorders among students are associated with cognitive impairments and real-world functioning [8]. The psychological impact among students extends further to the risk of adopting maladaptive behaviors, including binge drinking, smoking, substance abuse, overeating, risky sexual activities, dependence on social media, and sleep deprivation [8–10]. Stigma and embarrassment are also commonly associated with mental health problems among youth [11].

In December 2019, COVID-19 emerged as a public health threat and slowly became a worldwide pandemic, showing no curtailment signs while writing this manuscript [12]. COVID-19 has placed a considerable health burden and taxed the health care services around the world. Besides having a direct impact on physical health, it has had a severe toll on the psychological well-being of individuals due to fear, uncertainty, quarantine measures, lockdowns, social isolation, "infodemic" (or outpouring of news through various outlets, including social media), and so on [13–16]. In a study performed in India's postphase two lockdown period, college students had higher stress and anxiety levels than the general population [17]. Many universities have closed in-person classes, vacated dormitories, and introduced online teaching, which has led to tremendous academic stress among students [18]. The adverse psychological outcomes have been compounded for students who are already facing higher levels of distress. Loneliness and insufficient perceived social support are detrimental to mental health [19], both of which have been accentuated in the COVID-19 pandemic. A mixed-methods study done at a public college in the United States found that 71% of the respondents had higher stress and anxiety with associated stressors of fear, worry, lack of concentration, and disruption in sleep during the COVID-19 pandemic [20]. College students who have recently moved away from their families are particularly susceptible to social deprivation and feelings of loneliness [21].

Further studies on students conducted in France, Ethiopia, China, and Malaysia also point at a high negative impact on college students' psychosocial health during the COVID-19 pandemic [22–24]. A study of college students in China found that the prevalence of post-traumatic stress disorder and depression rose to 2.7% and 9.0% during the COVID-19 pandemic [25]. Silva Junior et al. (2020) have published a protocol for conducting a systematic review on studying the psychological consequences of COVID-19 among young adults. However, no meta-analysis has yet been performed [26]. While the pooled estimates indicating the psychological impact of COVID-19 were reported for different population groups, including healthcare workers, the general population, and patients with pre-existing disorders, the collective evidence on college students' mental health still needs to be quantified [17,27–30]. Against this backdrop, this study attempts to conduct a meta-analysis of peer-reviewed published studies on the burden of psychological indicators among college students following the COVID-19 pandemic.
