**2. Psychological Consequences of the Pandemic**

The outbreak of the SARS-CoV-2 pandemic has become an extremely pronounced stressor, which has extended to almost all of the countries worldwide. The fast spread of the pandemic was observed to affect all groups in society. At the current state of knowledge, it is believed that not only the pandemic alone but also the regulations and political measures that aim to prevent the spread of the virus have a significant impact on

the mental health of societies. Researchers addressed the psychological and behavioral responses of people during the early stage of the COVID-19 pandemic and noticed higher depressive, anxiety, and stress symptoms in the general population [15,16,18,21–24]. Some researchers observed that particularly students' psychological health was more influenced by the pandemic crisis compared to the other groups but presented with similar stress and anxiety levels [15]. There is some evidence that youths have reported depressive symptoms at a higher prevalence than the older ones [23]. A systematic review by Xiong et al. showed that the major risk factors associated with mental distress during the COVID-19 pandemic primarily included the student status, female gender, age groups <40 years old, unemployment status, as well as the presence of either psychiatric or other chronic diseases [25]. In a study that combined the population of 113,285 individuals, it was demonstrated that the prevalence rate and intensity of depression, anxiety, and stress were significantly higher during the pandemic; besides, sleep disturbances and more intense psychological distress were also observed in a studied population [26]. During the first weeks of the pandemic outbreak, about half of the Chinese respondents' reported a moderate-to-severe psychological impact, whereas one-third of the studied group moderate-to-severe anxiety [15]. Similar to the above-mentioned studies, student status and female gender were associated with greater levels of depression, anxiety, and stress. In the general population of Austria, depressive and anxiety symptoms were up to five and three times more prevalent, respectively, compared to the results obtained before the outbreak of the pandemic [27]. Unemployment, financial instability, and a lower income, in general, are major economic factors that might exaggerate both psychological and mental consequences during a pandemic [28–30]. Even though the outbreak began in China, a study comparing the distress between Poles and Chinese showed that Polish society tends to present significantly higher depression, anxiety, and stress levels [31]. Generally, younger individuals are more susceptible to depressive, anxiety, and stress symptoms related to the pandemic, comparing to the older population [32]. According to the most recent studies, the pandemic seems to affect individuals in all age groups. Several factors such as student status or female gender tend to additionally exaggerate psychological distress; however, there are also protective factors such as social support, proper relationships with family and friends, or the absence of any mental illnesses [33]. A study by Epifanio et al. performed in Italy during COVID-19 lockdown showed that younger adults (18–34 years old) presented with the lowest levels of psychological health, constituting the most vulnerable subjects in the general population at the same time [34]. Since numerous studies have already reported that students are most vulnerable to emotional distress during the pandemic, it is of great importance to find the risk and protective factors associated with the emotional distress in this group [35–39].

Therefore, the aim of this study was to (1) evaluate depression, anxiety, and stress levels among students from Polish universities during the first weeks of the COVID-19 pandemic, (2) assess the risk factors that increase the probability of the higher intensity of emotional distress, (3) create a portrait of a student who requires enhanced emotional support during the pandemic, (4) compare the results of our study with the results of research from other countries, that have also assessed the emotional well-being of the students during the first stages of COVID-19 lockdown with the usage of the same psychological tools.

### **3. Materials and Methods**

### *3.1. Study Design and Survey Description*

Before the survey preparation, the authors performed an independent review of the literature regarding the impact of the COVID-19 pandemic on mental health with a particular emphasis on the students. Subsequently, a structured questionnaire was created, including four parts: (1) sociodemographic data, (2) questions related to one's health condition, (3) economic situation, and (4) Polish adaptation of the Depression, Anxiety, and Stress Scale-21 (DASS-21) to assess depression, anxiety, and stress levels [40]. An

anonymous online cross-sectional survey included the questionnaire that was distributed on 20 April 2020 via social media among Polish students from 87 universities, including all medical universities in Poland. The survey was prepared via a Google form and was posted on social media groups on Facebook that gather students from Poland. The questionnaire was also sent via e-mail to other universities in Poland with a request to distribute it to the private groups at universities as well. The survey was closed on 26 April. Therefore, it was conducted almost 6 weeks after applying the lockdown measures in Poland on 10 March. Hereby, the snowball sampling method was utilized. The respondents were completing the survey individually in an estimated average time of about 10 min. All the answers given by the respondents were confidential, and only those who were conducting the research had access to the answers.
