Remote learning and students’ mental health during the Covid-19 pandemic: A mixed-method enquiry

Abstract

The disruption caused by Covid-19 in the educational sector may last longer than originally predicted. To better understand the current situation, this article analyses the mental health status of university students during the pandemic and investigates the learning conditions needed to support students. The sample included 557 undergraduate students who took part in an online survey. Overall, the students reported coping well during lockdown but indicated that lecturers were challenged by distance teaching, which created some stress for the students.

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Remote learning andstudents’ mental health
duringtheCovid‑19 pandemic: Amixed‑method enquiry
SuzanneLischer1 · NetkeySafi1· CherylDickson1
Accepted: 12 December 2020
© The Author(s) 2021
Abstract The disruption caused by Covid-19 in the educational sector may last longer
than originally predicted. To better understand the current situation, this article analyses
the mental health status of university students during the pandemic and investigates the
learning conditions needed to support students. The sample included 557 undergraduate
students who took part in an online survey. Overall, the students reported coping well dur-
ing lockdown but indicated that lecturers were challenged by distance teaching, which cre-
ated some stress for the students.
Keywords Remote learning· Covid-19· Stress· Mental health· Switzerland
In light of rising concern about the current Covid-19 pandemic, a growing number of uni-
versities across the world, beginning from March 2020, either postponed or cancelled all
such campus events as workshops, conferences, sports (both intra- and inter-university),
and other activities.Universities moved rapidly to transfer various courses and programmes
from face-to-face to online teaching (Sahu 2020). Due to the continuing sharp rise in the
number of infections, the Swiss Federal Council declared the “extraordinary situation” as
early as March 16, 2020, passing an ordinance that placed massive restrictions on public
life. Primary schools as well as universities had to close immediately. Since June 8, Swiss
universities were able to resume their teaching activities, under the condition that they
apply strict security measures; however, teaching will remain restricted for an unlimited
* Suzanne Lischer
suzanne.lischer@hslu.ch
Netkey Safi
netkey.safi@hslu.ch
Cheryl Dickson
dr.cheryldickson@live.com
1 Lucerne University ofApplied Sciences andArts–Social Work, Werftestrasse 1, 6002Lucerne,
Switzerland

S.Lischer et al.
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period. Colleges and universities are thus facing decisions about how to continue teaching
while keeping their faculty, staff, and students safe from a deadly virus emergency that is
moving fast and not well understood (Hodges etal. 2020).
Within this context, the question arises as to how to tackle the latent threat of Covid-19.
As pharmaceutical interventions such as vaccines are on the horizon but not yet available,
universities, even after the end of lockdown, must apply nonpharmaceutical interventions,
including social and physical distancing to slow the spread of the disease and prevent the
emergence of new diseases. Having been thrust into online learning, literally overnight,
academics have been debating what will become the “new normal” for our institutions and
teaching practices, and what is the best way forward (Tesar 2020).
On the one hand, the potential of digital technologies to enhance student learning had
already been well established before the outbreak. In the last few years, much enthusiasm
has surrounded the development of digital technologies along increasingly personalised,
remote, adaptive, and data-driven lines. The concept of blended learning to combine the
benefits of face-to-face and online teaching is gradually being integrated into institutions
(Dziuban etal. 2018), and digital technologies are clearly integral to the future of univer-
sity education around the world (Henderson etal. 2017). Faculty training to support this
transition—as well as student engagement and connectedness—has been identified as cru-
cial to its success (Barr and Miller 2013). Whilst the use of already-familiar applications,
such as WhatsApp, proved useful for remote-learning during the early pandemic (mid-
March), research has highlighted the need for more effective practices for the post-emer-
gency stage (Wargadinata etal. 2020). However, due to the sudden emergence of Covid-19,
most faculty members faced unforeseen challenges, including lack of online-teaching expe-
rience, lack of time for preparing distance-learning courses, and figuring out how to make
use of support from educational technology teams (Bao 2020). Thus, students and teachers
faced problems when studying and teaching at home. Literature highlights certain deficien-
cies, such as the weakness of online-teaching infrastructures, the inexperience of teachers
regarding new technologies, the information gap, the complex environment at home, and
so forth (Ali 2020). Furthermore, students have a wide range of distractions when studying
at home. For example, not all are able to find suitable spaces for home learning, or study-
ing may be constrained by insufficient hardware and unstable networks (Zhang etal. 2020).
Findings suggest that students, as well as the general population, may be experienc-
ing psychological effects from the outbreak of Covid-19, such as anxiety, fear, and worry,
among others (Cao et al. 2020; Li et al. 2020; Wang etal. 2020). A longitudinal study
reveals that, compared to prior academic terms, individuals in the Winter 2020 term were
more sedentary, anxious, and depressed. In addition, a wide variety of behaviours, includ-
ing increased phone usage, decreased physical activity, and fewer locations visited, are
associated with fluctuations in Covid-19 news reporting (Huckins etal. 2020). Findings
from China in February 2020 indicate that college students’ anxiety regarding the pan-
demic was associated with their place of residence, source of parental income, whether
living with parents, and whether a relative or an acquaintance was infected with Covid-
19 (Cao et al. 2020). Some students might be at higher risk of social isolation and the
development of mental health problems during the Covid-19 crisis. This is particularly
true when they live by themselves, have less direct contact to close family members and
friends, receive less social support, and are less well-integrated into a social network of
students. Female students appeared to be at higher risk of facing negative mental health
consequences (Elmer etal. 2020).

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Aim
The disruption caused by Covid-19 in the educational sector may last longer than expected
if a reliable solution for the virus is not found quickly and its spread continues. In this
study, we aim to highlight the potential impact of the Covid-19 outbreak on the education
and mental health of university students. We investigated and analyzed the mental health
status (in particular, anxiety) of university students during the pandemic for the following
purposes: (1) to evaluate these students’ emotional situation during the pandemic; (2) to
find out what learning conditions that university management and lecturers should estab-
lish in order to provide the best possible support for students during this pandemic or a
future epidemic/pandemic.
In this article we examine the following questions:
• How do students at the Lucerne University of Applied Sciences and Arts perceive the
university’s support during the coronavirus pandemic?
• Which sociodemographic characteristics are associated with increased anxiety?
• To what extent were the students distressed—both psychologically and regarding the
study workload—during the outbreak?
• Which Covid-19–related stressors are correlated with anxiety during the pandemic?
• What are, in the students’ views, the challenges and benefits of integrating distance
learning in tertiary institutions, in response to the Covid-19 crisis?
Method
We launched the survey for this cross-sectional study on April 23, 2020 and received
responses through the end of May 2020. We designed and conducted the survey using the
Enterprise Feedback Suite (EFS) Survey by Questback. The Central Switzerland Ethics
Committee approved this study.
Study population andsample
The study population is all undergraduate students at the Lucerne University of Applied
Sciences and Arts is N = 5,200, across six faculties. The relevant departments informed the
students about the survey in various ways (email, department website, and/or wider univer-
sity website).
A total of 557 students took part in the survey. All participants voluntarily gave their
informed consent to participate after being informed about the purpose of the study. The
questionnaires were anonymous to ensure confidentiality and the reliability of data.
Variable specification
Sociodemographic variables
We asked participants to report on their gender (male or female), age group (18–24, 25–34,
35–44, or 45–55years), nationality (Swiss or non-Swiss), migration background (yes or
no), discipline studied, living situation including relationship status (4 categories; see

S.Lischer et al.
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Table1), number of children, and household type (6 categories; see Table1). For the pur-
poses of the analysis, the variable living situation was ultimately dichotomized into catego-
ries for cohabiting and for living alone in the community.
Anxiety. In addition to sociodemographic questions that addressed the students’ situ-
ation during the Covid-19 pandemic, the survey included a validated anxiety scale. The
Table 1 Demographic characteristics of the sample and associations with PHQ-4 scores
a Effect sizes defined as follows: “small, d = .2, η2 = .02”, “medium, d = .5, η2 = .13”, “large, d = .8,
η2 = .26”
Total
sample
PHQ4 Group differences
n % M SD P value Effect sizea
Gender Female 286 63.8 1.9 0.7 .002 d = 0.31
Male 162 36.2 1.7 0.6
Age group 18–24 252 45.7 1.8 0.6 n.s.
25–34 236 42.8 1.9 0.7
35–44 46 8.3 1.7 0.7
45–54 18 3.3 1.5 0.4
Nationality Swiss 489 88.9 1.8 0.6 n.s.
Non-Swiss 61 11.1 2.0 0.8
Migration background No 484 89.7 1.8 0.6 .015 d = 0.25
Yes 54 10.1 2.1 0.8
Discipline Social Work 225 40.4 n.s.
Engineering & Architecture 190 34.1
Information Technology 3 .5
Art & Design 104 18.7
Music 11 2.0
Business 24 4.3
Relationship status Spouse/partner, living in the house-
hold
148 29.9 1.9 0.8 n.s.
Spouse/partner living outside the
household
125 25.3 1.8 0.6
No spouse/partner 169 34.1 1.8 0.6
Another form of relationship 53 10.7 1.8 0.6
Number of children No children 486 92.2 n.s.
1 child 24 4.6
2 children 11 2.1
3 children 6 1.1
Household type Single-person household 53 10.0 1.9 0.7 .032 η2 = .027
Couple with no children 113 21.3 1.9 0.8
Couple with child(ren) 56 10.5 1.5 0.5
Single-parent household with
child(ren)
70 13.2 1.8 0.7
Non-family household with several
people (e.g., shared house)
161 30.3 1.8 0.6
Other 78 14.7 1.7 0.7

Remote learning andstudents’ mental health duringtheCovid‑19…
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4-item Patient Health Questionnaire-4 (PHQ-4) is a rapid self-reported measure. Respond-
ents rate their symptoms using a 4-item Likert rating scale ranging from 1 (not at all) to
4 (almost every day), and the total score ranges from 0 to 16 (Löwe etal. 2010). We used
Cronbach’s α (Cronbach 1951) to measure the scale’s reliability—the internal consistency.
The PHQ-4 is a well-validated screening instrument, demonstrating a high internal consist-
ency (Cronbach’s ɑ = 0.81). The scale categorises the severity of clinically relevant depres-
sion and/or anxiety according to the PHQ-4 score, as follows: normal (1–4), mild (4–8),
moderate (9–12), severe (13–16).
Covid-19–related stressors. We assessed Covid-19–related stressors using a set of ques-
tions. which were constructed by a group of researchers at the University Hospital Frank-
furt. The first question, operationalized into 3 items, examined what effects students feared
might occur as a result of the Covid crisis: Worry about economic impact; worry about
loss of social contact; and worry about academic delays. A 3-point scale was used to rate
each item, as follows: So far, it is not an issue (1); that is what I fear (2); has already hap-
pened (3) (Frankenberg etal. 2020b).
The second question examined concerns about health and the social environment. The
survey asked students about the statements: I worry over personal health issues (becoming
depressed); and, I worry about health issues for people close to me (e.g., parents, grandpar-
ents). Respondents reported their answers using a 4-item Likert rating scale ranging from
strongly disagree (1) to strongly agree (4) (Frankenberg etal. 2020a).
Experiences with remote studying during the Covid-19 pandemic. We asked open-ended
questions about participants’ experiences with home study during the outbreak, inviting the
students to report on the challenges and advantages of home study. In addition, we asked
them how they perceive the support given by the university and what kind of response they
would like to receive.
Data analysis
We analyzed data using SPSS Version 22.0. We conducted an analysis of the descrip-
tive statistics to illustrate demographic and other selected characteristics of the respond-
ents (e.g., students’ self-reported anxiety levels) and used a one-way analysis of variance
(ANOVA) to compare the means (PHQ-4 scores) between different groups (e.g., gen-
der). We ran a regression analysis to explore the significant associations between Covid-
19–related stressors (worry about: economic impact, delays in academic activities, loss of
social contact, own health, and health of others) and different levels of self-reported anxi-
ety (normal, mild, moderate, severe). We employed MAXQDA 2020 to analyze the stu-
dents’ qualitative responses concerning home-study experiences during the outbreak.
Results
In Table1, we present the demographic and selected characteristics of the study popula-
tion. Among the sample of 557 undergraduate students who took part in the survey, from
a total of six faculties, 448 provided information on their gender. The majority of respond-
ents were female, and the mean age was 27 (median, 25). The response rate from the dif-
ferent faculties varied considerably: Social Work (40.4%), Engineering and Architecture
(34.1%), Information Technology (0.5%), Art and Design (18.7%), Music (2.0%), and
Business (4.3%).

S.Lischer et al.
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Anxiety levels
Factors influencing anxiety levels: Univariate analysis (ANOVA)
The findings indicate that women had significantly higher mean anxiety scores (PHQ-4)
when compared to men (F[1, 446] = 9.661, p = .001), respectively. However, the effect
size was small (p = .002, Cohen’s d = .319). We observed no significant difference in mean
anxiety scores with regard to age (p = .057); also, there was no group difference in mean
anxiety scores regarding nationality (Swiss vs. non-Swiss). Regarding migration back-
ground, students who had not migrated had significantly higher mean anxiety scores when
compared to those who had migrated (F[1, 443] = 8.501, p = .015). This effect was also
very small (p = .015, d = 0.25). Differences in relationship status and number of children
were not related to the PHQ-4 mean scores. Couples with children had significantly lower
average anxiety values than single-person households, couples without children, etc. (F[5,
447] = 2.468, p = .032, η2 = .027).
In conclusion, it appears that an increased PHQ-4 score is not related to certain sociode-
mographic characteristics. The differences found (gender, age, migration background, type
of household) have no significant effect.
Table2 shows how the mental health of college students was affected to varying degrees
during the outbreak. Of the responding students, 85.8% reported experiencing anxiety, for
which the symptoms, in the majority of cases, can be classified as “mild”.
Correlation betweenCovid-19–related stressors andPHQ-4 anxiety scores
We show, in Table3, the results of the regression analysis between Covid-19–related stress-
ors and PHQ-4 anxiety levels. Concerns about the economic impact of the pandemic were
positively related to the college students’ levels of anxiety (r = 0.117, P < .05). Moreover,
Table 2 Students’ self-reported
anxiety levels (n = 458) Anxiety level n Ratio (%)
Normal 65 14.2
Mild 290 63.3
Moderate 75 16.4
Severe 28 6.1
Total 458 100
Table 3 Regression analysis
of COVID-19-related stressors
and self-reported anxiety levels
(PHQ-4)
Related stressor Anxiety level
R P
Worry about economic impact .117 .033
Worry about academic delays .135 .006
Worry about loss of social contact .073 .132
Worry about personal health issues (becom-
ing depressed)
.194 .000
Worry about health issues for close others
(e.g., parents, grandparents)
.171 .000

Remote learning andstudents’ mental health duringtheCovid‑19…
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concerns about academic delays (r = 0.135, P < .01) or over personal health issues (becom-
ing depressed) (r = 0.194, P < .001) and worry about health issues for close others (e.g.,
parents, grandparents) also positively correlate (r = 0.171, P < .001) with the level of anxi-
ety. Worry about loss of social contact was not correlated with anxiety levels (r = .073,
P = .132).
Students’ experiences ofdistance learning
As part of the open-ended questions about students’ experiences of distance learning, we
asked them to report on what challenges and what opportunities distance learning brings in
response to the Covid-19 pandemic. N = 370 of 557 students (66%) answered the question
“What works well [regarding your current challenges in distance learning]?”; and 406 stu-
dents (72.9%) answered the question “What are the difficulties?”.
As the following results show, the students handled the new situation pragmatically.
While some students tackled the work with a high degree of discipline and explicitly
emphasized the advantages of the increased personal responsibility and independent work-
ing, (n = 82), others expressed difficulties in concentrating and maintaining the necessary
motivation for distance learning (n = 76). For some students (n = 24), time management
was a particular challenge. Structural conditions, such as having only one room serving as
both bedroom and study, complicated the situation. Eight students stated that they had dif-
ficulties with the limited available space.
Even though the students had already dealt with IT before Covid-19, the abrupt change
to exclusively digitalized communication channels was a challenge. Students did not cope
equally well with the technical requirements. Some saw the setup of the different IT tools as
complex. Whilst some students emphasized that the technology worked perfectly (n = 17),
other students complained about technical problems (n = 10), such as the slow internet con-
nection. Overall, however, they assessed the tools (e.g., for the learning platform or video
communication) as practical (n = 24). In particular, they very much appreciated the use
of zoom for providing the classroom and for bilateral discussions (n = 57). However, they
sometimes perceived group discussions via zoom as sluggish (n = 10).
If teachers give distance-learning work assignments, it is important from the students’
point of view that these are given at an early stage, that the assignment is clear, and that
they know what further steps may be needed. Furthermore, the opportunity to clarify
ambiguities must be provided, and the required workload must be proportionate. A total
of n = 23 students emphasized that the work assignments were didactically meaningful
and that the lecturers adequately communicated them. The performance of the lecturers
received mixed reviews, though this is also the case for face-to-face classes. For example,
the fact that teachers uploaded PowerPoint presentations to the learning platform without
setting them to audio was seen as unhelpful (n = 11); n = 17 students negatively appraised
the unstructured uploading of teaching materials to the learning platform Ilias. Group work
in distance learning was described as challenging and sometimes unnecessary. Students
expressed their wishes that this learning method be used carefully and purposefully in a
digital environment (n = 39). Students’ comments included:
Every lecturer has a different idea of how distance learning should work. A grid
would help. Ideally, for example, this grid structure would be useful: In the run-up to
the course, students prepare themselves by reading, then the topic is explained in an
online sequence by a lecturer. Afterwards, there should be an opportunity to clarify
questions and discuss the issue.

S.Lischer et al.
1 3
Work assignments are delivered in advance, there are forums available for questions.
Clear assignments, I can easily, sometimes even more simply, acquire most of the
module contents in Distance Learning.
However, n = 11 students were critical about their experience. In particular, the extra work-
load and the partly unclear communication caused the students problems. Comments were
related to: increased planning effort to coordinate video conferences (different tools and
different information channels are used), extra deadlines due to the changeover to distance
learning, extensive self-study without additional explanation. The fact that different learn-
ing platforms are used was perceived as frustrating. In this context, students also discussed
the digital competence of the lecturers, which they perceived as varying widely. One said:
Zoom meetings are tiring but good for discussions, some of the lecturers lack digital
literacy.
Sixteen students reported uncertainties about exam preparation. Not surprisingly, students
explicitly welcomed the university’s concession that they would not, in any circumstances,
be marked as having “failed” the exam and that examination forms were adapted to take
into account the actual teaching they had received.
Respondents’ discussion reflected controversy over communication on the part of the
university management. Overall, negative feedback with regard to communication predom-
inated (n = 16). In particular, students evaluated critically the “flood of emails and informa-
tion” to which they were exposed; they saw lecturers’ email communication as uncoordi-
nated in some cases. Eleven students stated that they missed the direct exchange with the
lecturers and, in particular, concrete feedback on work assignments that they had done.
A total of n = 51 students stated that they lacked personal exchanges with fellow stu-
dents. However, they also noted that, on occasions where such exchanges had been pos-
sible, these had been highly appreciated (n = 10).
The overall conclusion is that the majority of students would like to see a return to face-
to-face classes. N = 50 students were critical of Covid-19 conditional distance learning and
would like to see a return to the teaching methods used before the outbreak. At the same
time, 42.5% of the students agreed with the statement that a switch to higher levels of dis-
tance learning should also be targeted for the period after the Coronavirus pandemic.
Limitations andfuture directions
The current study has several limitations that could be addressed within future research.
Firstly, of the approximately 5200 students at the university, only 557 students across all
departments took part in the survey. This is a moderately low response; the results are
therefore not representative. Second, students in some fields, such as music or computer
science, are barely represented in the sample. In view of the fact that the area of study
plays a very important role in the discussion about the advantages and disadvantages of
distance learning, this is a major constraint of this study. The different response rates can
be explained by the fact that invitations to participate in the study were distributed in dif-
ferent ways. The Departments of Social Work, Engineering and Architecture, and Art and
Design sent the invitation by email with the survey link, while the Departments of Infor-
mation Technology (IT), Music, and Business only posted it on the department’s website
or on the internal website, without explicitly referring to the survey. Moreover, we did
not find strongly significant effects on mental health. However, the exploratory evaluation

Remote learning andstudents’ mental health duringtheCovid‑19…
1 3
using open-ended questions raises useful issues for further research work, such as whether
student satisfaction will increase once streamlined digital processes and personalized sup-
port measures are fully integrated.
Conclusions
The Covid-19 outbreak has disrupted the lives of many people across the world. The rapid
increase in cases of infection, worldwide, has created uncertainty and anxiety about what is
going to happen. It has also caused a tremendous level of stress among students. Previous
studies have suggested that public health emergencies such as the Covid-19 pandemic can
have many psychological effects on college students, which can be expressed as anxiety,
fear, and worry, among others (Cao etal. 2020; Huckins etal. 2020; Li etal. 2020; Wang
etal. 2020). This stress may lead to unfavourable effects on the learning and psychological
health of students (Sahu 2020).
Whilst not designed to be representative, the survey aimed to gain insight about poten-
tial impact of the Covid-19 outbreak on the education and mental health of undergraduate
students. The survey gathered n = 487 responses from undergraduate students who are stud-
ying in one of the 6 departments of the Lucerne University of Applied Sciences and Arts.
Regarding anxiety and stress, the study reveals that 85.8% of the students reported symp-
toms of anxiety, although in the majority of cases these symptoms were mild (63.3%). The
study did not confirm previous findings that students who live alone are at higher risk of
developing mental health problems (Elmer etal. 2020). However, female students appeared
to be at higher risk of facing negative mental health consequences, even though the effect
size is small. Due to the cross-sectional nature of this study, we cannot know whether these
symptoms existed before the pandemic. Yet, there are several plausible explanations for
why students may feel stressed or anxious during the Covid-19 outbreak, including addi-
tional study-related uncertainties or worries about career prospects.
Nevertheless, the results of the survey suggest that the students coped well with stresses
that occurred during the lockdown. Moreover, the majority of the students felt well sup-
ported and expressed their appreciation of the lecturers. However, this is no reason for
either the university management or the lecturers to rest on their laurels. The results of the
open-ended questions indicate that distance teaching was a challenge for lecturers, which in
turn created stress for the students. Thus, perhaps more than anxiety and stress, the expe-
rience of a rapid online transition to remote teaching has revealed much about the defi-
ciencies of the higher education sector and, perhaps, much about what needs to change in
universities (Watermeyer etal. 2020). Lecturers as well as students have to be prepared for
future times that require flexibility and probably a higher workload, and greater effort in
order to study. Digital literacy is no longer a “nice to have” but dispensable competence for
both lecturers and students. There are many reasons to believe that Covid-19 has created
“a new normal” for the universities—one that will continue after the lockdown ends. The
rapid evolution of Information Communication and Technology (ICT) and the increasing
complexity that comes with its vast potential explains why integration of technology in
education continues to receive special attention, particularly in the wake of the Covid-19
pandemic (Ali 2020). It is up to university management to provide both lecturers and stu-
dents with the necessary tools to acquire these competences.

S.Lischer et al.
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Funding Open access funding provided by Lucerne University of Applied Sciences and Arts.
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maps and institutional affiliations.
Suzanne Lischer has worked as a lecturer and project manager at the University of Applied Sciences and
Arts–Social Work (HSLU) since 2008. She has been the head of the Centre of Competence for Prevention
and Health, Lucerne, Switzerland, since 2017. Her main teaching and research interests focus on health-
related issues.
Netkey Safi has worked as senior scientific collaborator at the University of Applied Sciences and Arts–
Social Work (HSLU) since 2019.
Cheryl Dickson is a clinical psychologist with experience in clinical work and research. She specialized,
post qualification, in the field of child and adolescent mental health, and, subsequently, in the field of gam-
bling disorders.