Analyzing The Barriers and Supports for the Mental Health Needs of Occupational Therapy

Students During The COVID-19 Pandemic Within The PEO Model

Jayna Harishchandra, Elizabeth Lowry, Katelyn O’Kelley, and Te’aja Praylow

Lenoir-Rhyne University
Abstract

The purpose of this study was to examine the impacts the coronavirus disease 2019

(COVID-19) had on senior occupational therapy students’ mental health at Lenoir-Rhyne

University. Occupational therapy students had to transition to an online learning format which

altered their coursework, labs and clinicals. Data was collected using a survey to gather

information about students' perceptions of barriers and supports to their mental health during this

transition. The Person-Environment-Occupation (PEO) Model was incorporated into the survey

to view the students through an occupational lens and see which domain would have the

strongest influence on their mental health. For this quantitative study, 55 out of a possible 82

participants responded. Many respondents identified changes in their mental functions during

COVID-19 as compared to before the pandemic. When students perceived what the biggest

barrier and support to mental health was, results indicated that “Changes in my occupations” was

reported as the overall greatest barrier to mental health at 43.6% and personal factors were

reported as the overall greatest support to mental health at 47.3%, however when asked multiple

questions that considered each factor, the cumulative answer indicated that environment was

actually the biggest barrier to mental health. The results also indicated that prior knowledge of

mental health, self-awareness and resilience all supported mental health during the pandemic.

Further studies are needed in order to gather data from a larger demographic, explore the impact

of different coping strategies for students during a difficult transition, and the effect of mental

health occupational therapy services on students during a difficult transition.

Introduction

The coronavirus disease 2019 (COVID-19) has had serious consequences that have changed

peoples lives not only physically but mentally as well. Several studies have conveyed how much

of an impact COVID-19 has had on psychological health and well-being compared to before the

pandemic and how new stressors have arisen during these times. At Lenoir-Rhyne University,

senior occupational therapy students have had to adapt to changes in their coursework, lab

practicals and clinicals due to COVID-19. These changes have caused new mental health needs

for occupational therapy students. The barriers and supports to mental health needs across the

gamut of Lenoir-Rhyne University occupational therapy students is being analyzed through the

Person-Environment-Occupational (PEO) Model. This is significant because it allows for the

surveying of personal factors, environmental factors, and occupational factors- detecting which

is most influential to mental health among the students. This research study consisted of a

quantitative methods design to assess the mental health of occupational therapy students during

the COVID-19 pandemic. By using the data collected by the quantitative study, researchers will

be able to determine how each domain in the PEO model has an impact on supports and barriers

to mental health. The data will be collected via survey. The results of this study will provide

guidance to educators and students alike, by highlighting aspects of virtual learning that both

hinder and support successful learning in an online format. It will also provide future direction

for ways in which virtual programs can facilitate the best mental health supports for occupational

therapy students.

Background and Literature

 The coronavirus disease 2019 (COVID-19) has impacted the lives of many. COVID-19

is a serious global health threat (Global COVID-19, 2020). COVID-19 is not just a physical

health concern but also a mental health one. “Along with its high infectivity and fatality rates,

the 2019 Corona Virus Disease (COVID-19) has caused universal psychosocial impact by

causing mass hysteria, economic burden and financial losses.” (Dubey et al., 2020, p.779).

Forced lockdowns and quarantines can produce acute panic, anxiety, obsessive behaviors,

hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long term

(Dubey et al., 2020). Studies have conveyed that there has been lower psychological well being

and higher scores of anxiety and depression in the general public compared to life before the

COVID-19 pandemic (Vindegaard et al., 2020). Nationwide lockdowns have occurred and many

peoples normal routines have been changed. Many people have had to work from home,

participate in online school, and have been confined to their homes. A study revealed that college

students in Bangladesh had psychological distress because they were in fear of losing an

academic year and were adverse to e-learning (Hasan & Bao, 2020). Son’s et. al., (2020) study

conducted in the United States regarding the mental health of college students portrayed that the

stressors from the COVID-19 outbreak were the following:

Fear and worry about their own health and of their loved ones (177/195, 91%), negative

impacts of the pandemic difficulty in concentrating (173/195, 89%), disruptions to

sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing

(167/195, 86%), and increased concerns on academic performance (159/195, 82%). (p.4)

In order to cope with this stress and anxiety, these college students have pursued support from

others and have helped themselves by adopting either positive or negative coping mechanisms

(Son et al., 2020).

 At Lenoir-Rhyne University, senior occupational therapy students have had to adapt to

changes in their coursework, lab practicals and clinicals due to COVID-19. Students are now

learning from home and attending condensed in-person learning experiences and these changes

have caused new mental health needs for occupational therapy students. This study will look at

the supports and barriers for the mental health needs of occupational therapy students during the

COVID-19 pandemic using the PEO (Person, Environment, Occupation) model.

The PEO model examines how a person, their environment and their occupations

dynamically interact with each other over time (Strong et. al., 1999). A healthy balance between

the person, environment and occupation results in optimal occupational performance.

Occupational performance is the ability to engage in meaningful activities or occupations within

an environment (Strong et. al., 1999). Occupational performance can change in times of stress.

The transition from a bachelors degree to a masters degree, insurance reimbursement changes,

and shifting models of practice, occupational therapists have endured many changes throughout

the history of the profession that has taken an emotional toll on their well-being (Howard, 1991).

Lenoir- Rhyne University’s senior occupational therapy students are also preparing to enter a

significant transition in their lives from being students that are doing online learning during a

pandemic to being entry level practitioners. Stress will hinder many students' occupational

performance but some students will be able to perform better during these times than others.

Emotional intelligence could possibly be the determining factor behind better occupational

performance. A study about emotional intelligence, its relationship to stress, coping, well-being

and professional performance in nursing students conveyed that nursing students with increased

emotional regulation are better able to effectively cope with stress which then in turn helps their
well-being. The study revealed the importance of regulating students' emotions can increase

quality of life (Por et. al., 2011).

Social scientist and author, Brene Brown discusses how resilience is an important

characteristic trait to have in times of emotional stress. She explains how people should have a

‘tolerance for discomfort’ and says that people who can effectively cope during difficult

situations are more aware of their ‘emotional worlds’ (Baer, 2015). Reframing emotions and

self-awareness could be an effective strategy for occupational therapy students to manage during

this unexpected and unwelcome time period.

Results

For this quantitative study, 55 out of a possible 82 participants responded (67% response

rate). 90% of the respondents were female, 7.3% were male, and the remaining percentage of

respondents preferred not to report their gender. The majority of the respondents described their

ethnicity as Caucasian at 83.6%, and 9.1% described themselves as African-American. 1.8% of

students were Latino and another 1.8% were “other.” 3.6% of the respondents were Asian.

63.6% of the respondents were categorized as 24-26 year olds, 21.8% of participants were

between the ages of 21-23 years old, 9.1% were 27-28 years old, and 5.5% of participants were

29 years of age or older.

Many respondents identified changes in their mental functions, which is represented in

Figure 1, during COVID-19 as compared to before the pandemic. 50.9% of respondents reported

being neutral for executive function skills during versus before COVID-19. However, 23.6% of

respondents reported their executive functioning skills negatively changing during COVID-19 as

compared to before and 25.5% of respondents reported a greater change in executive functioning

skills during COVID-19 compared to before COVID-19. Attention to tasks was the next topic of
mental function change during COVID-19: 32.7% of participants responded as neutral and

36.4% responded as having a negative change in their attention to tasks during the pandemic as

compared to before. 30.9% of participants reported having a greater attention to task during the

COVID-19 crisis as compared to before. 43.6% of the participants reported having an increase in

memory during the COVID-19 pandemic as compared to before. 29.1% of the participants

responded as having a decrease in memory functioning during the pandemic versus before the

pandemic. 49.1% of the participants in the study reported emotional regulation as a negative

change during the COVID-19 pandemic as compared to before the pandemic and 29.1%

responded as having a positive change during the pandemic. The remaining percentage of

respondents, 21.8%, reported as neutral. 67.2% of the participants reported having a decreased

level of energy and motivation during the pandemic as compared to before the pandemic. 16.4%

of the participants responded as neutral and 16.4% of the respondents reported having an

increased level of energy and motivation during the pandemic. Sleep quality among the

participants seemed to have improved during the COVID-19 pandemic as reported by 41.8% of

the participants and 32.8% of the participants reported having a negative change in sleep quality

during the COVID-19 pandemic as compared to before the pandemic.

Figure 1. This bar graph takes the questions from the survey, puts a PEO view on it, and averages the students (55)

who chose a rating that was either a barrier, neutral or support to their mental health.

Many supports and barriers to positive mental health were reported by the participants.

Some of the supports of mental health during the COVID-19 pandemic included the following:

physical health at 69.1%, daily habits and routines at 69.1%, physical home environment at

61.8%, family/friendships/peer relationships at 87.2%, leisure and hobbies at 76.3%, social

participation at 64.8% and health maintenance routines at 60%. Some of the barriers to mental

health during the COVID-19 pandemic included the following: virtual learning environment at

41.8%, community and government at 74.6%, worker role at 36%, and student role at 41.9%.
Figure 2. This chart shows the greatest support to mental health during the pandemic as reported
by the respondents.

“Personal factors” was reported as the overall greatest support to mental health at 47.3%.

“Occupations” were reported as a greatest support by 25.5% of the respondents. The third

greatest support to mental health was the environment at 18.2%.

Figure 3. This chart shows the greatest barriers to mental health during the pandemic as reported
by the respondents.
“Changes in my occupations” was reported as the overall greatest barrier to mental health at

43.6%. “Changes in my environment” was reported as a greatest barrier to mental health at

38.2%. The third greatest barrier to mental health was “changes in personal factors” at 10.9%.

Overall, as senior occupational therapy students, the value of personal positive mental

wellbeing was identified by 98.2% of the respondents. Personal resilience was perceived by

76.4% and self-awareness was identified by 80% of the participants.

Significance and Conclusion

The onset of Covid-19 was rapid, as was the shift across the United States to encourage

social distancing and transitioning classrooms to virtual learning platforms. The shift to virtual

learning was abrupt and began with many students leaving for spring break, only to later learn

that they would not be returning to campus for the remainder of the semester. This sudden and

significant change to daily routines along with the removal of attending synchronous classes in-

person was rated as a significant barrier to mental health in occupational therapy students. As

seen in the evidence, although students rated their biggest barrier as changes in occupation, the

data shows that the environmental changes were the most disruptive to mental health.

We believe that students were reporting their change from in person learning to virtual as

a change in occupation. However, this is actually a change to the environment since students are

still attending virtual classes nearly everyday. Therefore, we are unable to write off the

environments of our occupational participation as insignificant. While occupation undoubtedly

matters, so does the environment in which these occupations are taking place, nor can we

downplay the significance of the nearly lifelong conditioning that students have received

portraying that learning and school take place in a classroom, not in our homes. Students also

reported a decline in their ability to regulate emotions since the onset of COVID-19 and the
drastic alteration to their daily occupational performance. This reinforces the entire premise of

occupational therapy and its significance in mental health. The results of this survey fortify the

idea that occupational participation in ways that are meaningful to our clients is critical to mental

health.

Possession of prior knowledge of mental health was shown to be a salient support to the

overall mental health of occupational therapy students during the pandemic. This knowledge

likely correlated with the high ranking of physical health as a support as exercise is widely

known to increase mental health. Personal resilience was also rated as a notable support to

mental health.

Limitations and Future Studies

Due to the unanticipated development and duration of the pandemic, we were unable to

obtain data about mental health supports and barriers in occupational therapy students during

times when there is not a global pandemic. Additionally, our study was relatively homogenous in

demographics as the results were largely made up of responses from white women.

Future studies about mental health promotion, emphasizing the student role, the

importance of a consistent learning environment, increasing emotional intelligence, and

consistent occupational engagement among occupational therapy students would be beneficial to

the future generation of occupational therapy practitioners.

 References:

Baer, D. (2015, September 01). One of America's most loved authors says the most resilient

people have these traits in common. Retrieved November 18, 2020, from

https://www.businessinsider.com/brene-brown-on-resilience-2015-8

Dubey, S., Biswas, P., Ghosh, R., Chatterjee, S., Dubey, M. J., Chatterjee, S., Lahiri, D., &
Lavie,

C. J. (2020). Psychosocial impact of COVID-19. Diabetes & metabolic syndrome, 14(5),

779–788. https://doi.org/10.1016/j.dsx.2020.05.03Psychosocial impact of COVID-195

Global COVID-19. (2020). Retrieved November 09, 2020, from

https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/index.html

Hasan, N., & Bao, Y. (2020). Impact of "e-Learning crack-up" perception on

psychological

distress among college students during COVID-19 pandemic: A mediating role of "fear

of academic year loss". Children and youth services review, 118, 105355.

https://doi.org/10.1016/j.childyouth.2020.105355

Howard B. S. (1991). How high do we jump? The effect of reimbursement on occupational

 therapy. The American journal of occupational therapy : official publication of the

American Occupational Therapy Association, 45(10), 875–881.

https://doi.org/10.5014/ajot.45.10.875

Keengwe, J., Adjei-boateng, E., & Diteeyont, W. (2013). Facilitating active social presence and

meaningful interactions in online learning. Education and Information Technologies,

18(4), 597-607. doi:http://dx.doi.org/10.1007/s10639-012-9197-9

Lattie, E. G., Adkins, E. C., Winquist, N., Stiles-Shields, C., Wafford, Q. E., & Graham, A. K.

(2019). Digital Mental Health Interventions for Depression, Anxiety, and Enhancement

of Psychological Well-Being Among College Students: Systematic Review. Journal of

Medical Internet Research, 21(7). doi:10.2196/12869

Ni, A. Y. (2013). Comparing the Effectiveness of Classroom and Online Learning: Teaching

Research Methods. Journal of Public Affairs Education, 19(2), 199-215.

doi:10.1080/15236803.2013.12001730

Por J, Barriball L, Fitzpatrick J, Roberts J. Emotional intelligence: its relationship to stress,

coping, well-being and professional performance in nursing students. Nurse Educ Today.

2011 Nov;31(8):855-60. doi: 10.1016/j.nedt.2010.12.023. Epub 2011 Feb 2. PMID:

21292360.

Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-19 on

College Students' Mental Health in the United States: Interview Survey Study. Journal of

medical Internet research, 22(9), e21279. https://doi.org/10.2196/21279

Strong, S., Rigby, P., Stewart, D., Law, M., Letts, L., & Cooper, B. (1999). Application of the

Person-Environment-Occupation Model: a practical tool. Canadian journal of

 occupational therapy. Revue canadienne d'ergotherapie, 66(3), 122–133.

https://doi.org/10.1177/000841749906600304

Willging, P. A., & Johnson, S. D. (2019). Factors That Influence Students’ Decision To Dropout

Of Online Courses. Online Learning, 8(4). doi:10.24059/olj.v8i4.1814

Vindegaard, N., & Benros, M. E. (2020). COVID-19 pandemic and mental health consequences:

Systematic review of the current evidence. Brain, behavior, and immunity, 89, 531–542.

https://doi.org/10.1016/j.bbi.2020.05.048