Impact of the COVID-19 pandemic on Psychological Well-being of Grade

10 students in Sarrat National High School

Researchers:
Shaina Luis
Nathaniel John Domingo
Kristel Ganiron

May 2022
ABSTRACT

The Philippines was a country to implement a national lockdown

because of the COVID19 pandemic. Worldwide, this pandemic had a huge
impact on the mental health of people in many countries causing similar
reactions in terms of emotions and concerns at the population level. Our study
investigated the impact of the COVID-19 pandemic on psychological well-
being of grade 10 students.
We did a web-based survey using Google Forms and distributed it to
several Grade 10 sections. To measure engagement, anxiety symptoms, and
depression symptoms in our sample, we utilized the Patient-Health-
Engagement-Scale, Self-Rating-Anxiety-Scale, and Self-Rating-Depression-
Scale.
 INTRODUCTION

The first outbreak of the novel coronavirus diseases (COVID-19) was

reported at the end of December 2019 in Wuhan, China and rapidly the virus
spread globally; on March 11, 2020, the World Health Organization declared a
pandemic state. The virus reached the Ilocos Region on March 20, 2020,
when the first cases of the disease were confirmed in the provinces of
Pangasinan and La Union. As of November 01, 2020, the Philippines
surveillance system had reported 2,826,410 cases and 47,074 deaths from
COVID-19, while during the first phase of the pandemic the highest case
fatality rate and one of the highest case mortality rates in our country was
reported. To limit the diffusion of the virus, the Philippine government
established a series of decrees aimed at containing the spread of the
epidemic.

First, on March 16, 2020, 11 municipalities in Northern Philippines,

including Metro Manila and Ilocos Norte, were placed on lockdown. Two days
later, the measures were extended to six regions, and on March 29, 2020, the
lockdown was extended to the whole national territory until May 12, 2020.
During this period, people could leave their homes only for specific needs
(work, health emergencies, and food and drug supplies), schools and
universities were closed, inter-regional mobility was suspended, and all types
of gatherings were prohibited. Inter-regional mobility was allowed after June 3,
and for the first time since May 6, 2020, it was for persons, residing in
different regions, possible to return to their places of residence. In some
regions, trustee home isolation was compulsory when individuals entered the
region.

As during the past outbreaks, such as those related to severe acute

respiratory syndrome (SARS), Influenza A, and Ebola, a number of experts
across the world anticipated that COVID-19 will affect the population’s health
in psychological, social, and neuroscientific dimensions. Indeed, the pandemic
led in the general population to a high incidence of mental health disorders,
such as acute stress, post-traumatic stress, anxiety, depression, irritability,
insomnia, and decreased attention, and these symptoms were more common
in individuals with epidemic-related experiences. In particular, the COVID-19
pandemic had a huge impact on the mental health of people in many
countries around the world causing similar reactions in terms of emotions and
concerns at the population level. In fact, an increase in mental health
disorders, especially anxiety and depression, in many Asian and European
countries — the first continents affected by the pandemic — was
demonstrated resulting in an anxiety and depression prevalence of 32.9 and
35.3%, respectively in Asia and a stress prevalence of 31.9% in Europe.
Considering the Philippines, as it was the mid country affected, the COVID-19
pandemic represented a novelty that generated fear, anxiety and depression,
especially in the young and elderly population, with a prevalence of anxiety,
depression and stress of 18.7, 32.7 and 27.2%, respectively.

We students of Sarrat National High School are a special social group

with active life habits based on relationships and contacts, physical, travel,
and gatherings. The pandemic emergency changed our life drastically
considering our school restrictions, indeed, teaching in attendance was
suspended from March 16, 2020, until the beginning of September 2020. Only
faculty and administrative technical staff were allowed to access the
campuses. At the same time, online teaching service had been activated,
through which lessons, exams, and these were carried out at distance.
Student attendance was allowed again in September and October, with a
combination of face-to-face and distance teaching with the possibility for
students to choose which method to use. Moreover, the lessons were
organized to avoid the presence of different course years to prevent
gatherings. As far as the health professions are concerned, traineeships in
hospitals have been maintained in presence. In this context, the almost 71
days of total pandemic might have facilitated the development of mental
health disorders, especially anxiety and depression. For these reasons, the
objective of this study was to evaluate the impact of the COVID-19 outbreak
on the well-being of a cohort of Sarrat National students during the first wave
of pandemic and related lockdown.
 LITERATURE REVIEW

The COVID-19 pandemic had a huge global influence on the lives and
education of more than 1.6 billion children at its height (UNESCO 2021).
Because of the lockdown, schools embraced and pursued remote learning
using video conferencing technologies. Teachers, students, and their families
have faced a variety of issues, including increasing stress and anxiety, which
has harmed their mental health. The problems have been exacerbated by
strict social distancing measures imposed as a result of a lack of vaccines and
high mortality rates (over two million deaths worldwide).

The first nation to be affected by the COVID-19 epidemic was China.

As a result, various research examining the influence of the pandemic on
students' mental health have been reported. A study discusses the issue of
mental health problems and suicidality among senior high school students in
China during the COVID-19 pandemic. Their study involved 859 high school
students (61.4% male and 79.4% below 16 years of age). Their results
showed that depression, anxiety, PTSD, and suicidal ideation, and suicidal
attempts were 71, 54.5, 85.5, 31.3, and 7.5% respectively. However, their
study did not specifically focus on specific stressors, though they surmise that
educational pressure, pronged school closure, and social stigma of COVID
infection might be stressors. Nevertheless, they report that higher exercise
frequency, a control in our study, correlated with fewer symptoms of
depression and anxiety. Another cross-sectional study of 532 Chinese high
school students by Zhang et al. (2020) used three types of questionnaires
from prior studies and showed that nearly 20% of the students’ mental health
was impacted. Their analysis showed that resilience and positive coping were
protective factors against depression, anxiety and stress symptoms. Another
cross-sectional study (Liang et al., 2020) of 584 youth (age 14–35) in China
showed that 40.4% were prone to psychological problems and 14.4% had
PTSD symptoms. In the context of COVID-19, their study suggested that
mental health was related to educational level, employment, and using
negative coping styles.

Asanov et al. (2021) discuss results from a cross-sectional survey of

over 1,500 high school students (age 14–18) in Ecuador. Their survey has
been conducted via phone interviews with the participants, focusing on topics
related to access to remote learning technologies and their impacts. They
used the MHI-5 index proposed by Veit and Ware (1983) that uses a five-point
Likert-like scale to assess their mental health along with a cutoff score of 17
(max score of 25), with higher scores indicating better mental health. Their
survey found 16% of participants had scores that indicate major depression.
Similarly, a longitudinal study involving 442 last year high school in Greece by
Giannopoulou et al. (2021) showed an 15.3% increase in depression, 17%
increase in severe depression, 25.7% increase in anxiety, and 16.7%
increase in severe anxiety after just one month of lockdowns. They use
Generalized Anxiety Disorder Scale (GAD-7), which is a 7-item questionnaire
with each item using a 4-point Likert-type scale to assess anxiety. They used
a modified version of the Patient Health Questionnaire-9, that also uses a 4-
point Likert-like scale, to assess depression.
METHODS

A web-based survey was conducted between May 5 and 7 of the year

2022. We administered an anonymous questionnaire of thirty-seven items and
were sent on the private messengers and group chats of Grade 10 Students
in Sarrat National High School. The Sarrat National High School has 9
sections in Grade 10: Armstrong, Maxwell, Mercury, Earth, Jupiter, Uranus,
Venus, Mars and Saturn. Participation was voluntary and unpaid. To
participate, students had to give their informed consent.

Instruments
Dependent Variables
We used levels of anxiety and depression as dependent variables of
this study. Students’ level of anxiety was assessed with the Zung Self-Rating
Anxiety Scale (SAS), which is composed of 20 items with 4 possible answers
(rarely, sometimes, often, most of the time) investigating anxiety levels based
on scoring of autonomic, cognitive, motor, and central nervous systems’
symptoms (such as “I feel more nervous and anxious than usual” or “I feel that
everything is alright and nothing bad will happen”). In this way, each item is
scored on a Likert scale ranging from 1 to 4. A total score < 50 corresponds
with absence of anxiety, while 50–59, 60–69, and > 70 indicate slight,
moderate, and severe anxiety, respectively.
Depression level was explored through the Zung Self-Rating
Depression Scale (SDS). The scale comprises 20 items covering affective,
psychological, and somatic symptoms associated with depression (such as “I
have trouble sleeping at night” or “I am restless and can’t keep still”). In this
case, there are also 4 possible answers (rarely, sometimes, often, most of the
time), and each item is scored on a Likert scale ranging from 1 to 4. A total
score < 50 corresponds to absence of depression, while 50–59, 60–69, and > 
70 indicate slight, moderate, and severe depression, respectively.

Independent Variables

General characteristics of students

Students’ demographic information (age, gender, date of birth), faculty,
year of study, residence region, health condition related to COVID-19, family
and friends’ health conditions related to COVID-19, and lifestyle during the
lockdown were collected.

Feelings and fears about the pandemic

The validated Patient Health Engagement Scale (PHE-S) evaluated
emotions, feelings, concerns, perceptions, and psychological engagement of
students. In particular, the scale consists of 9 items with scores of a purely
ordinal categorical and psychometric natures describing how people feel
when thinking about their own health (such as “I can’t understand what
happened to me” or “I feel positive”). Each sentence can be completed by
choosing one of 4 specific states or the intermediate points between two
states. According to the score obtained, each respondent is determined to
have 1 of the 4 levels of health engagement described by the PHE model (i.e.,
blackout, arousal, adhesion, eudaimonic project). The scale is based on the
assumption that the score a person obtains should reflect his or her actual
health engagement level. Moreover, 8 questions investigated the fear about
an increase of COVID-19 cases, deaths, risk of contagion, capacity to contain
the diffusion of the virus, and understanding of preventive measures.

Personal concerns regarding School studies

Specific items investigated personal concerns about School studies
during the COVID-19 pandemic (impossibility of attending university,
concentration, distance from colleagues, and fear of returning to school).
 RESULTS AND DISCUSSION

Fifty were collected questionnaires, of which 36 were used for the

analysis, with an effective rate of 90.27%. The SAS, SDS and PHE scales
showed high reliability rates, with a Cronbach’s alpha coefficient of 0.90 (95%
CI [0.88–0.91]), 0.89 [0.87–0.90] and 0.76 [0.72–0.80], respectively.
Table 1 provides a description of the general characteristics of the
students. Their median age was 16 and females accounted for 66.7% of the
total. Around 11.1% of the respondents were from section Mercury. Most of
the respondents were from Section Armstrong with 38.9% followed by
Maxwell with 36.1% respondents.
Of the students, 60% reported having engaged in physical activity
during the lockdown. Overall, 19.4% of the students reported suffering from
COVID-19-like symptoms, and, among the 10 who performed a swab test, no
one tested positive.

Table 1: General characteristics of students

Variable Category Number Percent

Age Median (IQR) =
16 (15-17)
Gender Male 12 33.3%
Female 24 66.7%
Section Armstrong 14 38.9%
Maxwell 13 36.1%
Mercury 4 11.1%
Uranus 2 5.6%
Jupiter 1 2.8%
Venus 1 2.8%
Saturn 1 2.8%
Known positive Yes 5 13.9%
cases
No 31 86.1%
Swab Yes 10 27.8%
No 26 72.2%
Positive Swab Yes 2 5.6%
No 34 94.4%
COVID-19-like Yes 7 19.4%
symptoms
No 29 80.6
Physical activity Yes 20 55.6
during lockdown
No 16 44.4

The sample size was 50, of which 20% were classified as anxious and
21% as depressed. Over 78% of respondents had a good understanding of
the preventive measures despite over 58.3% suffering from the impossibility
of physically seeing friends. Around 70% of students would have been willing
to contribute much more to face the pandemic. An increase in the
occurrences of anxiety was associated with being female.

Table 2 summarizes students’ personal concerns about their studies.

More than 67% of the students suffered from the impossibility of attending
school and 56% being distant from their fellow students. Others (72.2%)
reported being concerned about the possibility that the pandemic could
reduce their study activities, and 50% were concerned that the preventive
measures could hinder their studies. About 67% of the respondents stated
that they were worried about returning to school, and 78% were afraid about
their future careers due to the effect of COVID-19 on the country’s economy.
61.1% declared that they felt optimistic about a solution to the pandemic, and
89% declared that they were even more determined to complete their studies.

Table 2. Feelings and fears about the pandemic and PHE-Scale and
Personal concerns regarding university studies
Items Category N %
Pandemic feels Strongly 3 8.3
like something Disagree
distant Disagree 0 0
Moderate 10 27.8
Agree 18 50
Strongly Agree 5 13.9
Feel at risk of Strongly 1 2.8
being contagious Disagree
Disagree 2 5.6
Moderate 12 33.3
Agree 17 47.2
Strongly Agree 4 11.1
Fear about Strongly 2 5.6
containment of Disagree
the pandemic Disagree 3 8.3
Moderate 8 22.2
Agree 15 41.7
Strongly Agree 8 22.2
Fear about the Strongly 2 2.8
increase in Disagree
positive cases Disagree 1 5.6
Moderate 5 13.9
Agree 13 36.1
Strongly Agree 15 41.7
Fear about the Strongly 0 0
increase in Disagree
deaths Disagree 1 2.8
Moderate 4 11.1
Agree 12 33.3
Strongly Agree 19 52.8
Understand Strongly 0 0
preventive Disagree
measures Disagree 0 0
Moderate 8 22.2
Agree 17 47.2
Strongly Agree 11 30.6
Suffering from Strongly 1 2.8
the impossibility Disagree
of playing sports Disagree 3 8.3
outside during Moderate 11 30.6
the lockdown Agree 15 41.7
Strongly Agree 6 16.7
Suffering from Strongly 0 0
the impossibility Disagree
of seeing friends Disagree 5 13.9
during the Moderate 10 27.8
lockdown Agree 17 47.2
Strongly Agree 4 11.1
Desire to Strongly 1 2.8
contribute much Disagree
more to facing Disagree 0 0
the pandemic Moderate 10 27.8
Agree 20 55.6
Strongly Agree 5 13.9

Items Category N %
Suffering from Strongly 2 5.6
the impossibility Disagree
of attending Disagree 0 0
school Moderate 10 27.8
Agree 17 47.2
Strongly Agree 7 19.4
Suffering from Strongly 2 5.6
the distance from Disagree
fellow students Disagree 1 2.8
Moderate 13 36.1
Agree 14 38.9
Strongly Agree 6 16.7
Concerned about Strongly 0 0
 the possibility Disagree
that the Disagree 2 5.6
pandemic could Moderate 8 22.2
reduce one’s Agree 19 52.8
concentration on Strongly Agree 7 19.4
academic
activities
Concerned that Strongly 1 2,8
preventive Disagree
measures could Disagree 1 2.8
hinder one’s Moderate 16 44.4
studies Agree 12 33.3
Strongly Agree 6 16.7
Concerned about Strongly 0 0
returning to Disagree
school Disagree 2 5.6
Moderate 10 27.8
Agree 15 41.7
Strongly Agree 9 25
Concerned about Strongly 0 0
future career Disagree
because of the Disagree 0 0
COVID - 19 Moderate 8 22.2
pandemic Agree 16 44.4
Strongly Agree 12 33.3
Feel optimistic Strongly 1 2.8
about a solution Disagree
to the pandemic Disagree 1 2.8
Moderate 12 33.3
Agree 13 36.1
Strongly Agree 9 25
Determined to Strongly 0 0
complete studies Disagree
Disagree 1 2.8
Moderate 3 8.3
Agree 12 33.3
Strongly Agree 20 55.6

Concern about COVID-19, fear about the containment of the pandemic

and about the increase in positive cases and deaths were risk factors for the
occurrence of anxiety. Similarly, suffering from the impossibility of attending
school, distance from fellow students, and impossibility seeing friends was
associated with increased occurrence of anxiety. Additionally, the probability
of having anxiety was higher in students worried about the possibility that the
pandemic could reduce study activities, about returning to school, and about
their future careers due to the COVID-19 pandemic.
 SUMMARY AND CONCLUSION

After doing the survey using Google Forms and distributed it to several
Grade 10 sections. We can now measure engagement, anxiety symptoms,
and depression symptoms.
 Our study showed that students are at risk of psychological distress in
case of traumatic events, such as health emergencies. Since the evolution of
the pandemic is uncertain and the effects on mental health may be long term,
it is crucial to study the most effective interventions at school level, identifying
the most vulnerable subgroups and planning for acute and long-term
psychological services to control and reduce fear, and consequently burden of
psychological problems. Considering the didactic activities, we should
consider that school life is based on relationships, exchange of opinions and
“physical” confrontation. Moreover, our students show how anxiety and
depression are greatly related to distance from the environment, the
impossibility of attending school next year and confronting themselves with
their senior high. On the other hand, the pandemic has taught us that the
possibility of using digital tools to ensure teaching and functioning of schools
is of fundamental importance. In fact, owing to these systems, it has been
possible to continue school activities, without slowing down the study and
learning process of students. As far as our experience is concerned, students
accepted digital modes offered resulting in a wide participation in the lessons
and no difficulties related to the way the exams are carried out.
Therefore, the experience of online teaching can be considered more
than positive.

REFERENCES
WHO. (World Health Organization): Coronavirus disease (COVID-2019)
situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/situation-reports/. Retrieved on 1 May,2022. Accessed 02 May 2022.

Taha SA, Matheson K, Anisman H. H1N1 was not all that scary: uncertainty
and stressor appraisals predict anxiety related to a coming viral threat. Stress Health.
2014;30(2):149–57.
 Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Effects of COVID-19
lockdown on mental health and sleep disturbances in Italy. Int J Environ Res Public
Health. 2020;17(13):1–13.

Xiong J, Lipsitz O, Nasri F, Lui LMW, Gill H, Phan L, et al. Impact of COVID-
19 pandemic on mental health in the general population: a systematic review. J
Affect Disord. 2020;277(June):55–64 https://doi.org/10.1016/j.jad.2020.08.001.

Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, et al. A

nationwide survey of psychological distress among italian people during the covid-19
pandemic: immediate psychological responses and associated factors. Int J Environ
Res Public Health. 2020;17(9):1–14.

Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al. COVID-19

pandemic and lockdown measures impact on mental health among the general
population in Italy. Front Psychiatry. 2020;11(August):7–12.

Zung WW. A rating instrument for anxiety disorders. Psychosomatics.

1971;12:371–9.