Freshmen anxiety and COVID-19: Practical implications from an online intervention for supporting students affected by health inequities

Abstract

Objective

This study explored how college freshmen, particularly those affected by health inequities, are affected by COVID-19 and whether they would use a university-created online wellness intervention for help.

Participants

Nine-hundred and eighty-nine freshmen at a large southeastern university.

Method

Students responded to an online survey regarding their anxiety, worry, number of life disruptions, perceived resilience and their use of the online intervention during the pandemic (June to mid-September 2020).

Results

During COVID-19, Latinx, Black, women and non-heterosexual students reported significantly greater worry, daily life disruptions than their non-Latinx, white, male and heterosexual counterparts. Women and non-heterosexual students also reported greater anxiety and less resilience. Additionally, Latinx students reported using the university’s online intervention for help during COVID-19 more than others. Overall, freshmen, especially Black and women students, reported the online intervention would help them with struggles.

Conclusions

Universities should identify unique worries faced by students during a health crisis and provide institutional support. Practical implications are discussed.

Keywords:

• COVID-19
• freshmen
• health inequities
• online intervention
• survey

Introduction

The COVID-19 pandemic caused unprecedented disruptions to universities across the United States.¹ Beginning in March of 2020, most in-person classes were canceled, on-campus resources were closed, and students began to face a series of unique challenges.^1,2 As the virus continued to spread, and some universities chose to reopen, the Centers for Disease Control and Prevention (CDC) issued guidance to help maintain the health and safety of students.³ However, despite this advice, there remained problematic practical implications about how students would be affected, as many universities’ management and mitigation plans remained in limbo.⁴

Of particular concern was the mental well-being of university students in the wake of COVID-19.⁵ A national survey conducted in the second quarter of 2020 indicated that more than 60 percent of American college students felt that the pandemic made it more difficult to access mental health care.⁶ Despite this finding, universities might be forced to slash spending on mental health resources as schools cope with broader financial struggles resulting from the pandemic.⁴ As a result, there is a greater need for mental health resources that are both affordable and accessible.

One possible solution to increasing student well-being during this time of crisis is an online intervention. A growing body of research indicates that college students are already at high risk for mental health issues and that Web-based programs may reach students who are unlikely or unable to seek help.^7–9 One university in the southeast is currently implementing such an approach. The Student Resilience Project (strong.fsu.edu; hereinafter referred to as the Project) was launched by Florida State University in 2018 as an online tool to help students adjust to campus, improve mental health, increase resilience and reduce stress.¹⁰ The Project is a multimedia toolkit designed to train students on new resilience-building strategies and skills through the use of engaging animations, videos and audio sessions from students, faculty and mental health professionals.¹⁰ A scientific study of the Project prior to the pandemic showed that the program positively influenced students’ perceived self-efficacy to seek help, their intentions to practice more self-help activities, and their intentions to seek additional resources.^10,11 Such findings beg the question: Can programs like the Project be beneficial during the pandemic as students begin to face greater stressors than they have previously? Particularly, can students who are making the transition from high school to college (i.e., freshmen) during a pandemic find an online self-help portal helpful?

There are already identifiable groups of students who may need greater access to mental health and wellbeing resources to cope with the COVID-19 crisis, due to existing health inequities.¹² For example, research indicates that Latinx college students have less access to mental health resources and may face greater worries that lead to clinical health problems than their non-Latinx peers.¹³ Similarly, Black college students, as compared to other students, often face greater psychological distress and face more barriers to seek help.¹⁴ Gender and sexual orientation are also often considered predictors of mental health problems among college students. Specifically, females report greater proportions of depression and anxiety than males¹⁵ and those who identify as non-heterosexuals report greater mental health and academic issues than those who identify as heterosexuals.¹⁶ Therefore, it is imperative to consider how these group differences—especially among first-time college students—factor into programs aimed at influencing student well-being.

Literature review

The impact of public health emergencies on the mental health of college students

Increasingly, there are calls to explore the negative psychological impacts of COVID-19 because of concerns that it will exacerbate collegiate mental health issues such as anxiety and depression.^17,18 Due to the emerging nature of COVID-19, there are few scientific studies that have assessed its impact on the well-being of college students in the United States. Studies that are available, most of which were conducted in China, acknowledge a problematic shift in mental health and related behavior.^17,19,20 For example, Cao et al.¹⁹ found that nearly a quarter of college students surveyed in China experienced anxiety related to COVID-19 and as a result of these findings, the researchers’ practical recommendation was to “provide high-quality, timely crisis-oriented psychological services to college students.”^19(p4) Similarly, Liu et al.²⁰ found that the COVID-19 epidemic caused increased greater anxiety and depression among Chinese college students surveyed.

A study conducted in the U.S. found that at the onset of COVID-19 students had increased depression, anxiety, and sedentary time.¹⁷ These changes were noted as “above and beyond” what would normally be observed during a baseline (i.e., non-pandemic) timeframe. As a result of this documented, significant decline in mental health among college students, researchers called for rapid policy changes.

Mental health concerns among vulnerable college student groups

A number of studies have shown that the transition from high school to college can be stressful for students.²¹ Most mental health issues develop by emerging adulthood (ages 18–25),²² making college students a group particularly at risk of emotional and behavioral health disorders including anxiety, depression, non-suicidal self-injury,^23–25 and alcohol and substance misuse.^26–28 However, such prior research conducted with freshmen students has not examined possible effects of a worldwide pandemic. The current study aims to investigate this gap in the research—particularly among students who may already be experiencing health inequities, specifically, those who are Latinx, Black, women and non-heterosexual.

The U.S. Department Health and Human Services’ Office of Minority Health²⁹ reports that fewer than half of Latinx Americans have health insurance, making them the minority group with the least access to health coverage. Reported depressive symptoms³⁰ and suicide attempts in Latinx youth are higher than they are among their white peers³¹ while rates of help-seeking and mental health care are found to be lower. Less than 10% access mental health services: about half as many Latinx students receive mental health services as whites.²⁹ Barriers to help-seeking for these students include cultural stigma, lack of access to healthcare, distrust, and lack of clinical provider cultural competency.³⁰

Similarly, Black university students are at greater risk of higher stress levels than their white peers, and, as a result, often face more challenges to academic success.³² They also experience greater financial distress³³ and are at higher risk for depression, anxiety and other mental health issues.³⁴ Additionally, Black students utilize mental health services far less often than their white peers due to lack of access, cost or stigma.^34,35

Likewise, as a group, students who are women report higher rates of mental health diagnoses, psychological distress, depression, and lower resilience than men. Women experience misogyny, violence, physical and sexual abuse, discrimination, and entrenched gendered power imbalances.^36,37 Lifetime prevalence of anxiety for women is approximately twice as high as for men.³⁸ Because of the markedly disproportionate rates of anxiety experienced by women, The Women’s Preventative Services Initiative, supported by the Department of Health and Human Services (HHS), recommends screening for anxiety beginning in adolescence.³⁸

Another group of students identified as more likely to be diagnosed with a mental health disorder is those who identify as LGBTQ.^39,40 Rates of suicide attempts for LGBTQ high school students were almost five times that of heterosexual students.⁴¹ In addition, lifetime prevalence rates of substance misuse for LGBTQ individuals are up to five times as high as those for heterosexual and cisgender individuals.⁴¹ LGBTQ youth face chronic social stressors in the community, including homophobic and transphobic environments, school bullying, violence and abuse. Family rejection and homelessness are also prevalent among students who identify as LGBTQ.⁴²

COVID-19 and health disparities among Latinx, Black, women and non-heterosexual groups

In addition to making the transition to college tougher, COVID-19 is intensifying existing health disparities among minority populations in the United States.⁴³ For example, Latinx individuals have been disproportionately affected by COVID-19, comprising 31% of positive U.S. cases despite making up approximately 18% of the U.S. population.⁴⁴ Black students, who already endure the impact of racial trauma³⁴ also face a disproportionate risk of contracting COVID-19 and are especially vulnerable to sustained negative mental health effects.⁴⁵ The Trevor Project, a research and advocacy group on LGBTQ issues, emphasized the complications caused by COVID-19 for youth who identify as LGBTQ, pointing out that many students came out for the first time when they were at college, and were forced to go back home at the beginning of the pandemic to unsupportive, and even abusive, families. Such adverse circumstances cause additional stress for these young people.⁴⁶ There are also indications that women have paid greater attention to and worried more about pandemic than men.²⁰ According to the CDC, factors that increase the risk of exposure to, or poor health outcomes from COVID-19, include discrimination, higher rates of underlying health conditions, lower access to health insurance, and greater likelihood of living in multigenerational housing.¹²

Based on previous research that suggests ongoing and potentially acute vulnerabilities and need for resources among these groups, it was proposed that freshmen who identify as Latinx, Black, women, and non-heterosexual students surveyed during the COVID-19 pandemic would report (H1a-d) greater anxiety; (H2a-d) a greater worry about the impacts of COVID-19; (H3a-d) a greater number of daily life disruptions, and; (H4a-d) less resilience than their respective counterparts (i.e., non-Latinx, white, men, and heterosexuals).

Online mental health and wellness interventions

Research indicates that university students are more likely to use an online program that supports well-being than to seek in-person or professional help.^7,9 Beyond the ease of accessibility and low cost in the digital age, data indicate these programs’ effectiveness. Specifically, Web-based interventions can improve depression, anxiety and psychological distress among university students.^7,47 There is evidence that the most successful online health interventions have interactive elements, with layers of targeted, evidence-informed approaches.⁴⁸ Due to the potential of these online interventions to improve students’ well-being, there are increasing calls for more research to evaluate how they can be designed and delivered.⁴⁷

Description of The Student Resilience Project

The Project was designed with a trauma-informed approach that acknowledges and seeks to mitigate the negative impact of prior individual adversity, as well as the society-wide effects of racism, sexism and homophobia. Launched in 2018, the Project is a multimedia mental health promotion and resilience intervention uniquely crafted for college students. The primary goals of the Project are to help students face inevitable adversities by building coping/stress management skills, cultivating a sense of belonging and connecting them to university resources. Currently, the website is free and password accessible to all students at one university. Freshmen at the university are specifically recruited to take part in the project before registering for their second-semester classes.

Although the website was not initially designed with a pandemic in mind, the available content and resources can be of benefit to students during times of crises. The website features instructional and inspirational videos, skill-building activities, links to campus resources and mental-health information, and TED-talk style podcasts by campus experts. For example, a section of the site titled “Learn New Skills” helps students learn about mindfulness and meditation. These content features provide evidence-backed, practical and low-cost ways to support students.¹⁰ For example, research indicates that introducing mindfulness and meditation can offer a way to help with constant change—and help ease fears—during a crisis such as COVID-19.⁴⁹ Similarly, a section on the website titled, “Reach Out; Get What You Need” educates students on how to build connectedness with others. During the pandemic, this encouragement of human contact and support was augmented and highlighted as a recommended strategy for coping with COVID-19.⁵⁰ During the initial stage of the pandemic, content was also added to the site to acknowledge the disruption that COVID-19 was causing to many people’s lives while acknowledging feelings of uncertainty and turmoil. Specific encouragement was offered to students to learn techniques such as “grounding”—or focusing on objects or surroundings to anchor themselves in the present time and place in order to calm the body and mind—as well as breathing techniques to increase feelings of relaxation.

Thus, the following hypotheses were tested:

H5: Vulnerable student populations (i.e., Latinx, Black, women and non-heterosexuals) will use the Project for help during COVID-19 more than their counterparts (i.e., non-Latinx, white, men and heterosexuals).

H6a-b: Vulnerable student populations (i.e., Latinx, Black, women and non-heterosexuals) who visit the Project website during COVID-19 will indicate that the site helps them (a) learn about campus resources and, (b) take steps to get help with struggles/challenges while at the university more than their counterparts (i.e., non-Latinx, white, men and heterosexuals).

Method

Overview of procedure

An online survey was conducted using Qualtrics survey software from June through mid-September of 2020 to explore (a) how freshmen college students were responding to COVID-19; (b) their use of an online mental health and wellness intervention during the pandemic; and, (c) to identify particular student groups who may need the greatest access to mental health resources. Respondents, who had viewed the Project website, were recruited via a link on the final screen. The first 200 students to respond received a $5 gift card as incentive to participate. The timing of initial data collection was intended to take advantage of access to participants in a “Summer Bridge” program for first year, first generation students from socioeconomically disadvantaged backgrounds. The program provides an orientation to college life and academic support to ease the transition from high school to college. Students from this summer cohort who completed the study contributed to a diverse study sample in terms of race/ethnicity and sexual identity, thus allowing a more powerful test of differences in responses to question items across the different groups of interest. Research indicates the importance of including a greater representation of vulnerable populations, as they are understudied and under-consulted, especially when they are the subject of interest.⁵¹ This study was approved by the university’s institutional review board (IRB).

Respondents

A total of 989 undergraduate students at a southeastern university completed the online questionnaire. Respondents were freshmen, aged 18–19 years old (M = 18.09, SD = .28), many of whom were living with their parents (50.2%). The majority of students identified as women (65.9%), with 32.9% indicating they identified as men. About 60.2% of students reported they were white, 25.9% Black/African American, 6.7% Asian and the rest indicated various other races. Thirty-five percent of students indicated they were Latinx. Most students (80.3%) reported they identified as heterosexual while others identified as non-heterosexual (e.g., lesbian, gay, bisexual), and 2.5% preferred not to identify. More than 39% of students—nearly 40% of whom were Latinx—indicated a relative or acquaintance had tested positive for COVID-19.

Measures

Anxiety

Anxiety was assessed using a 7-item anxiety scale (GAD-7).⁵² For example, respondents were asked how often, over the past two weeks, they were bothered by: (a) feeling nervous, anxious or on edge, and; (b) feeling afraid as if something awful might happen. Response choices were “not at all,” “several days,” “over half the days,” and “nearly every day,” scored as 0, 1, 2, 3 respectively. Individual scores were summed. A score above 5 represented mild anxiety, a score above 10 represented moderate anxiety, and above 15 represented severe anxiety.⁵²

Worries related to COVID-19

Stressors related to COVID-19 were measured with eleven items adapted from previous studies of such stressors.^19,53 For example, respondents were asked to indicate on a four-point scale (1 = not at all worried; 4 = very worried) how worried they were about: (a) academic delays, (b) themselves or someone they know getting sick from coronavirus, and; (c) being unable to access medical care. Items were averaged together to create an index (α = .89, M = 2.71, SD = .71).

Disruptions to daily life due to COVID-19

Eight items, previously used by Ballew et al.⁵³ measured the amount and type of daily disruptions respondents faced as a result of COVID-19. For example, respondents were asked (yes/no) if they or a member of their household had experienced the following as a result of COVID-19: (a) lost income from a job or business, (b) had work hours reduced, and (c) had been unable to get adequate medical care. Items were summed together for each individual, for a total of 8 possible disruptions to daily life (M = 2.29; SD = 2.01).

Resilience

Respondents’ perceived resilience was measured using the six-item Brief Resilience Scale,⁵⁴ using a five-point scale (1 = strongly disagree, 5 = strongly agree). Sample items included: (a) It does not take me long to recover from a stressful event, and, (b) I usually come through difficult times without any struggle. Items were averaged to create a scale (α = .84, M = 3.36, SD = .80).

Intervention effectiveness

Respondents were asked if they had used the Project website to get help during COVID-19 (yes/no). To measure in what way the website might be helpful, the researchers created the following questions. Respondents asked on a five-point scale (1 = strongly disagree; 5 = strongly agree) if they felt the website could help them: (a) learn about campus resources available and, (b) take steps to get help with struggles/challenges faced while at the university.

Demographics and general risk perceptions

Respondents self-reported their age, gender, race, ethnicity, sexual orientation, and whether a relative/acquaintance had tested positive for COVID-19. They were also asked on 4-point scale (1 = not at all; 4 = a great deal) how much they thought COVID-19 would harm (a) their health personally, (b) the health of their family, (c) people within the university community, and (d) people within the United States.

Data analytic plan

Descriptive analyses were conducted with all variables. Chi-square tests of homogeneity were conducted to examine group differences (i.e., ethnicity, race, gender and sexuality) on anxiety (H1a-d) and use of the Project website during COVID-19 (H5). Independent samples t-tests were conducted to investigate group differences (i.e., ethnicity, race, gender and sexuality) on the variables of worry (H2a-d), number of daily life disruptions (H3a-d), resilience (H4a-d) and intervention effectiveness (perceived helpfulness) of the Project site (H6a-b).

Results

More than 64% of respondents reported they thought COVID-19 would: (a) harm their health “none” or “only a little,” and; (b) be harmful to the health of the university community. Ninety-seven percent of students felt that COVID-19 would harm the health of people in the U.S.

Levels of anxiety among freshmen groups

Among all freshmen respondents, 38.8% reported normal anxiety, 29% reported mild anxiety, 18.1% reported moderate anxiety and 14.2% reported severe anxiety. See Table 1.

Table 1. Levels of anxiety among freshmen respondents by ethnicity, race, gender and sexual orientation.

Anxiety	All freshmen	Ethnicity		Race		Gender		Sexual orientation
		Non-Latinx	Latinx	White	Black	Men	Women	Hetero	Non-hetero
Normal	38.8%	41.1%	34.5%	44.3%	29.3%*	53.8%	31.6%*	41.9 %	26.8%*
Mild	29%	29.9%	27.2%	26.1%	32.6%*	25.5%	30.8%	29.9%	22.6%
Moderate	18.1%	15.7%	22.3%	16%	22.7%*	12%	20.8%*	17.3%	20.8%
Severe	14.2%	13.2%	15.9%	13.6%	15.4%	8.6%	16.8%*	10.9%	29.8%*

* p < .0125.

H1a predicted that freshmen who identified as Latinx would report greater anxiety than freshman who did not identify as Latinx. However, there was not a significant relationship between ethnicity and anxiety. Thus, H1a was not supported.

However, the relationship between race and anxiety was significant, χ2(3) = 18.56, p < .001. A post hoc analysis was conducted with pairwise comparisons using multiple z-tests of two proportions with a Bonferroni correction. Statistical significance was accepted at p < .0125. There was a statistically significant difference in the proportion of white compared to Black students who had normal anxiety (n = 268, 44.3% vs. n = 80, 29.3%), mild anxiety (n = 158, 26.1% vs. n = 89, 32.6%), and moderate anxiety (n = 97, 16% vs. n = 62, 22.7%). Thus, white students had more normal levels of anxiety, while black students had higher levels of mild and moderate anxiety. White and Black students did not differ in severe anxiety. Thus, H1b was partially supported.

Gender and anxiety was also significant, χ2(3) = 49.21, p < .001. A post hoc analysis was conducted with pairwise comparisons using multiple z-tests of two proportions with a Bonferroni correction. Statistical significance was accepted at p < .0125. There was a statistically significant difference in the proportion of men compared to women who had normal anxiety (n = 175, 53.8% vs. n = 203, 31.6%) moderate anxiety (n = 39, 12% vs. n = 134, 20.8%) and severe anxiety (n = 28, 8.6% vs. n = 108, 16.8%), p < .0125. Thus, men had more normal levels of anxiety than women while women had more moderate and severe anxiety than men. Men and women did not differ in mild anxiety. Thus, H1c was partially supported.

The relationship between sexual orientation and anxiety was also significant, χ2(3) = 45.94, p < .001. Again, post hoc analysis involved pairwise comparisons using multiple z-tests of two proportions with a Bonferroni correction. Statistical significance was accepted at p < .0125. There was a statistically significant difference in the proportion of heterosexuals compared to non-heterosexuals who had normal anxiety (n = 329, 41.9% vs. n = 45, 26.8%) and severe anxiety (n = 86, 10.9% vs. n = 50, 29.8%), p < .0125, such that those who identified heterosexuals had more normal levels of anxiety than non-heterosexuals while non-heterosexuals had much higher levels of severe anxiety than non-heterosexuals. No other pairwise comparisons were statistically significantly different. Thus, H1d was partially supported.

Worry about impacts of COVID-19 among freshmen groups

Latinx students reported greater worry (M = 2.86; SD = .66) than non-Latinx students (M = 2.62; SD = .72), t(755.83) = −5.27, p < .01; Black students (M = 2.94; SD = .66) reported greater worry than white students (M = 2.56; SD = .71), t(875) = −7.51, p < .01; women reported greater worry (M = 2.78; SD =.68) than men (M = 2.56; SD = .75), t(964) = −4.62, p < .01 and; non-heterosexuals reported greater worry (M = 2.85; SD = .62) than heterosexuals (M = 2.67; SD = .73), t(274.02) = −2.98, p < .01. Thus, H2a, Hb, Hc and Hd were supported.

Further examination of specific worries revealed that Latinx students were significantly (p < .05) more worried than non-Latinx students in nearly all situations presented (e.g., not able to access medical care, less able to pay monthly bills, etc.), with the exception of: crime increasing where [they] live and returning to campus. Similarly, Black students reported significantly (p < .05) more worry than white students in all but one situation presented: a university closure. Women also reported significantly (p < .05) more worry than men in nearly every situation presented, except for: being able to access medical care or being unable to afford groceries. Similarly, non-heterosexuals reported significantly (p < .05) more worry than heterosexuals in more than half of the situations presented, except: losing work related income, crime increasing where [they] live, university closing, academic delays. See Table 2 for means and standard deviations.

Table 2. Means and standard deviations of worries among freshmen respondents by ethnicity, gender and sexual orientation.

Behavior	All freshmen	Ethnicity		Race		Gender		Sexual orientation
	M (SD)	Non-Latinx	Latinx	White	Black	Men	Women	Hetero	Non-hetero
Getting sick from COVID-19	3.16 (.94)	3.07 (.97)	3.34*** (.86)	3.06 (.98)	3.30*** (.90)	2.94 (1.03)	3.27*** (.88)	3.12 (.97)	3.33** (.80)
Unable to access to medical care	2.36 (1.09)	2.25 (1.07)	2.55*** (1.10)	2.17 (1.07)	2.66*** (1.07)	2.26 (1.08)	2.40 (1.09)	2.28 (1.09)	2.70*** (1.04)
Unable to pay bills	2.50 (1.56)	2.34 (1.13)	2.80*** (1.16)	2.23 (1.11)	2.96*** (1.11)	2.36 (1.46)	2.57** (1.16)	2.46 (1.45)	2.67* (1.20)
Unable to afford groceries	2.24 (1.07)	2.15 (1.05)	2.41*** (1.08)	2.04 (1.01)	2.59*** (1.10)	2.19 (1.05)	2.27 (1.08)	2.19 (1.07)	2.47** (1.06)
Unable to complete coursework.	2.72 (1.06)	2.61 (1.06)	2.91*** (1.04)	2.56 (1.07)	3.02*** (1.03)	2.51 (1.06)	2.82*** (1.04)	2.68 (1.07)	2.87* (.99)
Losing income	2.45 (1.14)	2.33 (1.10)	2.68*** (1.17)	2.24 (1.10)	2.85*** (1.12)	2.33 (1.15)	2.51* (1.12)	2.42 (1.14)	2.61 (1.11)
Crime increasing	2.05 (.98)	2.01 (.99)	2.14 (.97)	1.93 (.95)	2.21*** (1.04)	1.93 (.96)	2.12** (.98)	2.07 (1.01)	2.01 (.87)
Global economic depression	3.21 (.91)	3.16 (.92)	3.32** (.88)	3.15 (.94)	3.33 (.84)	3.05 (1.01)	3.29*** (.84)	3.18 (.93)	3.35* (.82)
University closure	3.26 (.93)	3.21 (.96)	3.35* (.86)	3.22 (.96)	3.35 (.90)	3.12 (1.01)	3.33*** (.88)	3.26 (.94)	3.28 (.88)
Academic delays	2.92 (.99)	2.82 (1.01)	3.10*** (.92)	2.79 (1.00)	3.13*** (.92)	2.78 (1.02)	2.98** (.96)	2.89 (1.00)	3.02 (.93)
Coming back to campus	2.72 (1.08)	2.67 (1.11)	2.81 (1.04)	2.58 (1.10)	2.91*** (1.07)	2.55 (1.14)	2.80*** (1.04)	2.66 (1.11)	2.95*** (.92)

Note. Standard deviations are presented in parentheses.

* p < .05.

** p < .01.

*** p < .001.

Daily life disruptions due to COVID-19 among freshmen groups

As predicted by H3a-d, Latinx students experienced a greater number of daily life disruptions (M = 2.12; SD = .12) than non-Latinx students (M = 2.10; SD = .08), t(968) = −3.95, p < .001; Black students (M = 2.85; SD = 2.15) experienced a greater number of daily life disruptions than white students (M = 2.04; SD = 1.95), t(871) = −5.52, p < .001; women (M = 2.39; SD = 2.08) experienced a greater number of daily life disruptions than men (M = 2.11; SD = 2.00), t(956) = −2.00, p < .05 and; non-heterosexuals (M = 2.84; SD = 2.17) experienced a greater number of daily life disruptions than heterosexuals (M = 2.18; SD = 2.02) t(943) = −3.74, p < .001. Thus, H3a-d were supported.

A closer examination of frequencies (for which respondents could indicate multiple response) revealed that greatest differences in life disruptions between Latinx and non-Latinx students were: (1) trouble sleeping; (2) inability to access medical care, and; (3) filed for unemployment benefits. The greatest differences between white and Black students were: (1) filed for unemployment benefits; (2) lost a job, and; (3) inability to get groceries. The greatest differences between men and women students were: (1) trouble sleeping; (2) lost income from a job or business, and; (3) work hours reduced. The greatest differences between heterosexual and non-heterosexual students were: (1) inability to access medical care; (2) lost job, and; (3) inability to get groceries. See Table 3 for frequencies.

Table 3. Daily life disruptions among freshmen respondents by ethnicity, gender and sexual orientation.

Behavior	All freshmen	Ethnicity		Race		Gender		Sexual orientation
		Non-Latinx	Latinx	White	Black	Men	Women	Hetero	Non-hetero
Lost income	55.7%	54.8%	57.1%	54.9%	58.5%	60.6%	54.1%	55.1%	60%
Work hours reduced	69.9%	68.1%	72.9%	67.7%	73.8%	66.1%	71.9%	69.8%	75.6%
Lost job	35%	33.9%	36.6%	32%	40.6%	36.2%	34.9%	33.6%	40.7%
Filed for unemployment	38.6%	36.9%	41.4%	35.7%	46.3%	38%	39.3%	39%	40%
Unable to get groceries	21.3%	22.2%	19.8%	18.9%	25.3%	24%	19.8%	20%	26.7%
Unable to get prescription medication	11.5%	11.1%	12.1%	9.2%	14.8%	11.8%	11.2%	10.7%	15.6%
Trouble sleeping	61%	57.2%	67%	62.6%	57.2%	50.2%	65.9%	59.4%	65.9%
Unable to get adequate medical care	18%	15.4%	22.3%	16.5%	20.5%	16.3%	18.8%	16.3%	26.7%

Note. These responses reflect the percentage of participants answering “yes” to the questions within each respective group. Within each group, the greatest difference in behavior is shown in bold.

Resilience among freshmen groups

Latinx students reported less perceived themselves to be less resilient (M = 3.29; SD = .82) than non-Latinx students (M = 3.41; SD = .79), t(979) = 2.26, p < .05; women reported less perceived resilience (M = 3.29; SD = .80) than men (M = 3.53; SD = .77), t(967) = 4.58, p < .001, and; non-heterosexuals reported less perceived resilience (M = 3.08; SD = .84) than heterosexuals (M = 3.43; SD = .78), t(953) = 5.19, p = .001. Thus, H4a, c and d were supported. There was no significant difference in reported resilience between Black and white students.

Intervention effectiveness

H5 predicted vulnerable groups of students (i.e., Latinx; Black women; non-heterosexuals) would report using the Project website to get help during COVID-19 more than their counterparts. Overall, descriptive statistics revealed that 23% of all students surveyed had used the website specifically for help related to COVID-19. A chi-square test of homogeneity indicated that 28.3% of Latinx students had used the Project website specifically for COVID-19 help, compared to 20.1% of non-Latinx students, a difference in proportions of .082, p < .01. There were no significant differences in used based on race, gender or sexual orientation. Thus, H5 was partially supported.

H6a-b predicted differences in how vulnerable groups of freshmen (i.e., Latinx; women; non-heterosexuals) who visited the Project website during COVID-19 would rate the site in terms of its ability to help them (a) learn about campus resources available and (b) take steps to get help with struggles/challenges faced while at the university. An analysis of means showed that most students overall agreed that the website would help them: learn about available resources (M = 4.29; SD = .89) and take steps to get help with struggles/challenges (M = 4.23; SD = .93). Independent samples t-tests indicated Black students found the website would help them: learn about campus resources (M = 4.51; SD = .75) more than white students (M = 4.20; SD = .93), t(639.93) = −5.39, p < .001, and; take steps to get help (M = 4.46; SD = .79) more than white students (M = 4.14; SD = .97), t(635.12) = −5.09, p < .001. Similarly, women found the website would help them: learn about campus resources (M = 4.38; SD = .83) more than men (M = 4.11; SD = .98), t(967) = −4.48, p < .001, and; take steps to get help (M = 4.34; SD = .85) more than men (M = 4.02; SD = 1.03), t(967) = −5.03, p < .001. There were no significant influences of ethnicity or sexual orientation on these perceptions of helpfulness.

Discussion

Well before the emergence of COVID-19, researchers noted that emerging adulthood is a critical period for developing positive coping strategies. Interventions such as the Project provide students an opportunity to learn about stress reduction, trauma, and building resilience, in addition to accessing more formal mental health counseling. Students who experience stress as minorities can benefit from having help processing resulting posttraumatic stress reactions.^55,56

This study offers further evidence that freshmen college students report being adversely impacted by COVID-19. Although more than 60% of those surveyed felt that COVID-19 would be of little harm to their health, many acknowledged it was causing them anxiety, worry and daily life disruptions. It is also clear that even though the pandemic affects all students to some extent, different groups of students reported facing greater adversity than others. For example, women and non-heterosexuals reported experiencing greater anxiety and less resilience than participants who identified as men and heterosexuals.

Particularly salient in the current study are data indicating that Latinx student participants reported more direct impacts from COVID-19 than their non-Latinx counterparts. As compared to non-Latinx freshmen, Latinx freshmen reported having more relatives and acquaintances diagnosed with COVID-19. They also reported experiencing greater worry and more daily life disruptions than non-Latinx students due to the pandemic. In particular, they reported more worry than other students about medical care access, ability to pay bills and academic delays. These same students also indicated a significantly greater number of disruptions to daily life than non-Latinx students. Above and beyond economic woes experienced by many students, Latinx students reported lack of sleep and inability to access medical care. Perhaps these health concerns are why Latinx freshmen in the sample were more likely to seek out the Project website for help than non-Latinx freshmen. These results indicate that these students likely have a greater need for mental health and wellbeing resources than other students. Prior research indicates the Latinx community faces greater barriers to mental health resources,^29,30 and it is possible that Latinx students turned to the Project website as an easily accessible and free alternative that, unlike traditional medical resources, they were not worried about being able to access.

The results from this study are also consistent with prior research indicating the Black students face greater mental health impacts from COVID-19 than their white peers.³⁵ As compared to white freshmen, Black students had greater worries and anxiety. They also reported experiencing more life disruptions, particularly those that cause financial distress (i.e., lost job, reduction in work hours, filing for unemployment benefits). The prevalence of these disruptions is especially problematic, as they may exacerbate barriers to help seeking that already plague Black students.

The results of this study are informing changes to the Project in order to better meet the needs of students during the pandemic, including content specifically acknowledging the needs of Latinx, Black, women, and LGBTQ students. Previously published data of Project use and evaluations indicate that resources specifically targeted to certain demographic groups are indeed heavily utilized by those groups. For example, data regarding usage of the Project “Real Talk ” audio on supporting LGBTQ students revealed that a majority of students who listened to the audio also identified as being LGBTQ.⁵⁷ Part of the unique nature of the Project is that it is trauma-informed, acknowledges students’ adverse childhood and community experiences, and then offers practical strategies for coping and healing.⁸ Additionally, Project researchers are also in the process of developing multimedia content in response to the needs of Black students. First, the project will be adding content to address the racial trauma, or race-based traumatic stress that Black students commonly experience well before they attend college, and then may also experience in a predominantly white institution. Adding such content highlights the chronic stress that community and systemic racism can cause and can help students recognize the impact of their own experiences, help them build coping skills and improve their resilience. In addition, multimedia anti-racism content is being developed to raise awareness about racism among all students, and to improve campus culture to support mental health and wellness for Black students. Universities interested in this approach can ensure that publicly available mental health resources are disseminated campus-wide to encourage mental health awareness and help-seeking. Universities should also offer students information about positive coping and resilience strategies during the COVID-19 crisis. See Table 4.

Table 4. Mental health resources to assist vulnerable students during COVID.

Type of mental health resource	Source	URL
Coping with stress during COVID-19	CDC (CDC)	https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html
Mental health support for young adults during COVID-19	CDC	https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/stress-coping/young-adults.html
Mental health and coping during COVID-19	U.S. Dept. of Health & Human Services	https://www.hhs.gov/coronavirus/mental-health-and-coping/index.html
COVID-19 mental health support and information guide	National Alliance for the Mentally Ill (NAMI)	https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID-19-Guide.pdf
Activities and emotional health resources for youth during COVID	Love is louder, project of JED Foundation	https://www.loveislouder.org
COVID mental health resources for LGBTQ youth	Trevor Project	https://www.thetrevorproject.org/2020/03/26/how-lgbtq-youth-can-cope-with-anxiety-and-stress-during-covid-19/
National helpline for immediate counseling during COVID	Substance Abuse Mental Health Services Administration (SAMHSA)	https://www.samhsa.gov/find-help/disaster-distress-helpline
National treatment referral and information service for individuals with mental and/or substances use disorders	SAMHSA	https://www.samhsa.gov/find-help/national-helpline
National helpline for suicide prevention and crisis resources	National Suicide Prevention Lifeline	https://suicidepreventionlifeline.org/

In addition to offering campus-wide support, universities that do not have an online tool can still provide specific, targeted support for vulnerable students, including increased outreach to Latinx, Black, women, and LGBTQ students. Although COVID-19 has had a disproportionate impact on some communities, it is important to avoid pathologizing those groups that have been subjected to disproportionate allocations of resources overall. Still, universities can provide these students with specific, trauma-informed information that acknowledges the specific negative impacts of prior adversity, as well as racism, homophobia, and sexism, on their mental health. Administrations can also support vulnerable students by inquiring about and listening to their expressed needs and can ensure space for student participation in the creation of targeted resources. Ensuring effective affinity group cross-communication between, for example, members of the Hispanic/Latino Student Union and other groups with large Latinx representation is one concrete way that administrations can improve their outreach efforts to students. Similarly, colleges should reach out to affinity groups, such as Pride Student Union and Women’s Student Union, to share research findings and to ask for input on campus improvements that might help students cope with the impact of COVID-19.

An additional recommendation is to ensure that upper administrations stay current on research regarding the impact of COVID-19 on different groups⁵⁸ and consider providing vulnerable campus groups with resources to deal with the disparate impact of the pandemic. The negative budgetary impact of COVID-19 at the university administrative level will require prioritizing funding, and budgetary apportionment should be informed by the research. For example, resources could be directed to trauma and cultural competency training for college mental health providers so they can more effectively address the specific needs of Latinx, women, and LGBTQ students who experience psychological distress.

Limitations

Although this study was conducted with scientific rigor, some limitations should be noted. Due to the ever-changing nature of the pandemic, it is likely that some of the students who need the most help may have been unable to respond to our survey. Similarly, not all freshmen in the university population were surveyed. That is, students who completed the survey were exposed to the Project website and therefore might have had different perceptions about its helpfulness/use during COVID-19 than students who were not-exposed. Additionally, many of the students who were recruited were participants in a university summer program that serves first-generation college students from socioeconomically disadvantaged backgrounds, which may have skewed the demographics of the sample. [This sampling phenomenon did, however, allow for reasonable examination of responses of students in the groups of interest in this study, who typically constitute a much smaller proportion of survey samples.]⁵¹ The present study could be a useful comparison as to how perceptions and behaviors are evolving over time.

Conclusion

COVID-19 has caused enormous disruptions in people’s lives. Colleges can work to lessen the effect by being aware of the disparate impact of the pandemic on certain groups, such as Latinx, Black, women and LGBTQ students. Regardless of the likely decrease in resources caused by the disruption of the pandemic, all institutions of higher learning can acknowledge and identify the additional struggles their students are experiencing because of COVID-19, and can offer targeted institutional support to promote mental health and wellness.

Conflict of interest disclosure

The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of Florida State University.

Additional information

Funding

No funding was used to support this research and/or the preparation of the manuscript.