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Chapter 1

THE PROBLEM AND ITS SCOPE

Introduction

The Sustainable Development Goals (SDG) set by the United Nations in 2015 is

a collection of 17 interlinked global goals designed to be a “blueprint to achieve a better

and more sustainable future for all’’ (UNSDG, 2015). It was adopted by all member-

states of the United Nations as a universal call to action to end poverty, protect the

planet, ensure healthy lives, promote well-being for all at all ages, and ensure that all

people enjoy peace and prosperity. Further, it aims to push for an inclusive and

sustainable world for all where countries, poor, rich and middle income, work together

and ensure that no one is left behind.

The 2030 Agenda recognizes the importance of good health to long-term

sustainability and the interconnectedness of the two. It takes into account widening

economic and social inequalities and the emerging challenges of mental health amidst the

COVID-19 pandemic. Further, mental health plays a key role in efforts to achieve social

inclusion and equity, universal health coverage, access to justice and human rights, and

sustainable economic development.

The AmBisyon Natin 2040, on the other hand, is the result of a long-term visioning

process for the Filipinos. It is a picture of the future, a set of life goals and goals for the

country and the vision that guides the future and is the anchor of the country’s plans

(NEDA, 2019). The Philippines is envisioned to be a prosperous middle-class society

where “no one is poor, people live a long and healthy lives, and are smart and innovative,

which underline the importance of developing new approaches to improve the Filipino

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way of life.” With this, the Philippines has been battling the spread of COVID-19, couple

with the surmountable challenges of addressing the most basic health and socio-

economic needs of the people. Almost all efforts and resources are geared towards saving

lives and mitigating socio-economic effects of deadly coronavirus with physical well-

being taking priority over mental health needs.

Although the COVID-19 crisis is, in the first instance, a physical health crisis, it

has the seeds of a major mental health crisis as well, if action is not taken. Good mental

health, enshrined in the UNSDG and the Ambisyon Natin 2040, is critical to the

functioning of society at the best of times. It must be front and centre of every country’s

response to and recovery from the COVID-19 pandemic especially for students at all

levels. The United Nations (2020) emphasized that mental health and wellbeing of whole

societies have been severely impacted by this crisis and are a priority to be addressed

urgently.

Mental health issues are the leading impediment to students in this trying times.

Mental illness can affect their motivation, concentration, and social interactions—crucial

factors for students to survive in higher education. The 2019 Annual Report of the Center

for Collegiate Mental Health reported that anxiety continues to be the most common

problem among students who completed the Counseling Center Assessment of

Psychological Symptoms, with clinicians also reporting that anxiety continues to be the

most common diagnosis of the students that seek services at university counseling

centers (Eysenbach, 2020). Indeed, several recent surveys of students suggest that

students’ mental well-being has been devastated by the pandemic’s social and economic

consequences.

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Given the immense importance of mental health among student-learners in this

time of COVID-19 pandemic, the researchers are strongly motivated to investigate their

health conditions.

Theoretical

The Broaden and Build Theory by Barbara Frederickson is a theory associated

with the field of positive psychology that explores the function of positive emotion in

building resiliency. This theory is based on the notion that positive emotions can have

the effect of broadening awareness and response to events as well as building resiliency

and coping skills. Mental health problems can affect student’s energy level,

concentration, dependability, mental ability, and optimism, hindering performance. The

premise of these of this theory is that both types of emotions must co-exist and that

positive emotions build resources to cope with negative emotions.

Studies and surveys conducted so far in the pandemic consistently show that

young people, rather than older people, are most vulnerable to increase psychological

distress, perhaps because their need for social interactions are stronger. On the other

hand, the broaden and build theory shows how to used positive emotions in building

resiliency in the times of global crisis.

Conceptual Framework

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Independent Variable Dependent Variable

Demographic Profile
Age
Mental Health
Gender
during the COVID-19
Year of Study
Pandemic
Family Income\

Living Condition

Figure 1. Conceptual Paradigm

Statement of the Problem

The study aimed to investigate the mental health of the BSED Social Studies

students in Jose Rizal Memorial State University Katipunan Campus in the time of

COVID-19 pandemic.

Specifically, it sought to answer the following questions:

1. What is the profile of the students in terms of the following?

1.1 age;

1.2 gender;

1.3 year of study;

1.4 family income;

1.5 living condition?

2. What is the profile of the students in terms of the following?

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3. What is the mental health of the student in the time of COVID-19

pandemic?

4. Is there a significant association between student’s mental health ?

Hypothesis

Ho1: There is no significant difference on the extent of mental health when grouped

as to age, gender, year of study, family income, and living condition.

Ho2: There is a significant difference on the extent of mental health When grouped

as to age, gender, year of the Study, family income, and living condition.

Significance of the Study

This study will benefit the following:

Students. The research would be beneficial to the students because they are the

main subject who were affected in this pandemic. In this study, the students will be

aware on the how the pandemic can affect their mental health and can be aware on how

to handle their emotions that can cause mental health problems in the midst of pandemic.

Teachers. This research would be beneficial to teachers because they will be able to

understand the changes of the behavior, perceptions of the life and academic

performances of the students that were engaged to stress, depression and other mental

issues. They can easily cope up to the student’s attitude online during this time of

pandemic.

Parents. This research would be help to the parents because they can know how

COVID-19 affects to their children at home, to their academic performances and into

their social life. The parents knowing the risk of mental health issues they can help and

prevent and avoid their child to be a victim of mental health problems by the existing of

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COVID-19 pandemic.

School and Administrator. This study will also benefit school administrators. It

will provide them information on the importance of knowing the mental health of the

students. It’s one way that the administrators will intensify mental health symposiums

that promote mental awareness in their school, improve the knowledge of their teachers

through seminars so that they can deal well with their students mental well-being.

Future Researchers. This study would be beneficial to the future researcher

because they can get some information that might needed in their research and some of

their questions may possibly be answered by the research. The result of this study will

motivate other researcher to conduct similar research on a bigger and wider scope.

Other Intellectuals. The same outputs provide psychologists, sociologists health

care workers, public administrators, educators, and social workers some insights into the

mental health of students in the COVID-19 pandemic.

Scope and Limitation of the Study

The study is focused to investigate the mental health of the BSED Social Studies

students in Jose Rizal Memorial State University Katipunan Campus in the time of

COVID-19 pandemic. The aspects looked into what how the pandemic brought changes

to the mental well-being of the students. The data of this study will be limited to those

obtained by the researchers from the questionnaires. All information that will be gathered

from this research will be kept highly confidential.

Definition of Terms

The following terms are defined operationally:

Anxiety. Is your body natural response to stress. It’s a feeling of fear or

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apprehension about what’s to come.

Confidentiality. It refers to ensuring that all relevant information related to

persons with psychiatric, neurologic, and psychological health needs is kept safe from

access or use by, or disclosure to, persons or entities who are not authorizes to access,

use, or possess such information.

COVID-19. Is a virus spreader, primary through droplets of saliva or discharge

from the nose when an infected person cough or sneezes.

COVID-19 Pandemic. This refers to the ongoing global pandemic of

coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2).

Depression. A serious medical illness that negatively affects how you feel, the

way you think and how you act. It is caused by the feelings of sadness and/or a loss of

interest in activities once enjoyed by the student. 

Impairment or Temporary Loss of Decision-Making Capacity refers to a

medically-determined inability on the part of a service user or any other person affected

by a mental health condition, to provide informed consent. 

Mental Health. It refers to a state of well-being in which the individual realizes

one's own abilities and potentials, scopes adequately with the normal stresses of life,

displays resilience in the face of extreme life events, works productively and fruitfully,

and is able to make a positive contribution to the community.

Mental Health Condition. It refers to a neurologic or psychiatric condition

characterized by the existence of a recognizable, clinically-significant disturbance in an

individual's cognition, emotional regulation, or behavioral that reflects a genetic or

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acquired dysfunction in the neurological, psychosocial, or developmental process

underlying mental functioning. The determination of neurologic and psychiatric

conditions shall be based on scientifically-accepted medical nomenclature and best

available scientific and medical evidence.

Mental Health Service. It refers to psychosocial psychiatric or neurologic

activities and programs along the whole range of the mental health support services

including promotion, prevention, treatment, and aftercare, which are provided by mental

health facilities and mental health professionals.

Mental Illness. Also called mental health disorder,refers to a wide range of

mental health conditions.

Mental Well-being. Is about your thoughts of feelings and how you cope with

the ups and down of everyday life.

Psychosocial Problems. It refers to a condition that indicates the existence of

dysfunctions in a person's behavior, thoughts and feelings brought about by sudden

extreme, prolonged or cumulative stressors in the physical or social environment.

Stress. Is a feeling of emotional or physical tension. .

Support. It refers to the spectrum of informal and formal arrangements or

services of varying types and intensities, provided by the State, private entities, or

communities, aimed at assisting a service user in the exercise of his or her legal capacity

or rights, including; community services; personal assistants and ombudsman; powers of

attorney and other legal and personal planning tools; peer support; support for self -

advocacy; nonformal community caregiver networks; dialogue systems; alternative, and

manual communication; and the use of assistive devices and technology.

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Chapter 2

REVIEW OF RELATED LITERATURE

With the global development of the corona virus disease (COVID-19) outbreak,

the psychological issues which accompany this pandemic have rapidly compounded its

public health burden (Torales et al., 2020). Emerging research assessing the mental

health implications of COVID-19 has identified a heightened prevalence of moderate-to-

severe self-reported depressive and anxious symptomatology among the general public

(Wang et al,. 2020), reflecting the widespread effects of uncertainty and health-related

fears. However, further research that investigates beyond the population level is required

to understand the individualized disruption of lives and routines as a result of COVID-

19, and its associated psychological impacts.

To date, one published study has explored the impact of COVID-19 on student

education and well-being (Cao et al., 2020). Approximately 25% of their sample

reported experiencing anxiety symptoms, which were positively correlated with

increased concerns about academic delays, economic effects of the pandemic, and

impacts on daily life. Furthermore, among the many student surveys administered

worldwide, one survey by YoungMinds reported that 83% of young respondents agreed

that the pandemic worsened per-existing mental health conditions, mainly due to school

closures, loss of routine, and restricted social connections (YoungMinds, 2020). As the

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number of COVID-19 cases on campus continues to rise, stress associated with the

pandemic has worsened mental health concerns for many students. In recent study

from the Centers for Disease Control Prevention, 74.9 percent of 18 to 24 years-old

reported having experienced mental health challenges, such as symptoms of anxiety and

depression. According to postdoctoral researcher Kaylin Ratner, human development,

college students often struggle with mental health more than as they navigate the

uncertain process of becoming independent adults.

However, common parts of emerging adulthood such as finding work have come

more challenging during the pandemic, which could exacerbate mental health concerns

for some young adults.

Mental health, health status and socioeconomic status are important determinants

of an individual’s well being. There are thought to be important interactions between

these dimensions of well being, with causal links running in both directions. Poor health

and poor mental health can reduce earnings ability, through their effects on education

and employment, and poverty can lead to lower educational attainment, poorer physical

health and depression (Ardington and Case, 2010).

Statistical analysis showed that there was a significant relation between mental

health and educational performance, that is, the higher the students’ level of mental

health, the better their educational performance. Moreover, there was a significant

relation between educational performance and certain components of mental health, such

as depression and anxiety; however, no significant relation was observed between

educational Mehdi Bostani et al. / Procedia - Social and Behavioral Sciences 116 (2014)

163 – 165 165 performance and other components of mental health (physical symptoms

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and disorder in social performance)

Children and adolescents with a low SES suffer from multiple stressful life

situations and are exposed to a higher risk of developing mental health problems. The

findings suggest that the reduction of socioeconomic inequalities and interventions for

families with low parental education might help to reduce children’s mental health

problems(Franziska Reiss 2019).

Two main mechanisms have been posited in understanding the link between

mental illness and income: social causation and social selection. Social causation posits

that adversity, stress, and reduced capacity to cope related to low income increase the

risk of development of mental illness. The social selection hypothesis suggests that

individuals with mental illness have a predisposition to declining socioeconomic status

due to possible genetic factors, hospitalizations related to mental illness, and/or loss of

work. These theories have been debated and there is some empirical support for

each. Classic work by Dohrenwend et a,l found that social causation theory was more

important for depression, substance use, and antisocial personality disorder (PD) than for

schizophrenia, which was better explained by social selection.

Most studies on income and mental health have been limited by the use of cross-

sectional data that do not allow for examination of temporal relationships between

income and mental disorders. A 7-year longitudinal study of adults in Great Britain

found that reductions in income and increases in self-reported financial strain were

associated with increased risk for depressive symptoms compared with no change in

income or financial strain. However, reductions in financial strain and increases in

income were not associated with a decreased risk for depressive symptoms. In contrast,

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another longitudinal study compared winners of medium-sized lotteries ($200 000) with

2 comparison groups (those with no winnings or small winnings). 7 The study found that

winners of medium-sized lotteries had significantly better psychological health, as

measured by the General Health Questionnaire, than the control groups. Although these

studies possess the strengths of longitudinal design and large samples, they were limited

by the use of self-report screening instruments that are not meant for diagnosis of mental

disorders. To the best of our knowledge, the only study that used a quasi-experimental

design and structured diagnostic interviews was recently published by Costello et

al. They examined a large sample of American Indian youth evaluated into adulthood

and demonstrated that family income supplements of $9000 per year were associated

with a decreased risk of mental disorders (Drs Sareen and Afifi, 2011)

Low levels of household income are associated with several lifetime mental

disorders and suicide attempts, and a reduction in household income is associated with

increased risk for incident mental disorders. Policymakers need to consider optimal

methods of intervention for mental disorders and suicidal behavior among low-income

individuals.

The recent global economic recession has promoted increasing concern about the

impact of decreasing income as a risk factor for mental disorders and suicidal behavior.

The media have reported increased rates of crisis calls to telephone support

centers. Despite this recent increase in media attention, there has long been an interest in

understanding the link between mental illness, suicide, life satisfaction, and

income. Once the basic needs are met (ie, food and shelter), higher levels of income have

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not been shown to be strongly associated with happiness or decreased risk of mental

health problems.

In recent years, “resilience” and its companion concept, “grit,” have become

buzzwords in higher education. Colleges have introduced wellness programs, campus

campaigns, even full-blown courses that incorporate meditation, yoga, reflective writing

and sketching, and stress-management techniques like deep breathing (Sarah Brown

2020).

Fredrickson (1998) argues in her theory The Broaden and Build theory that while

negative emotions narrow thought-action repertoires, positive emotions broaden these

repertoires, enabling us to draw on a wide array of possible conditions and behaviors in

response to emotional stimuli.

According to her theory, The Broaden and Build negative emotions narrow

thought-action repertoires, while positive emotions broaden this same repertoire. This

means that positive emotions should ‘undo’ the lingering effects of negative emotions by

facilitating this broadening process.

According to the Broaden-and-Build Theory of Positive Emotions, we are most

likely to acquire these resources while experiencing positive emotions. To draw again on

the above examples, we will probably be more motivated to get out of bed and do a

muscle-strengthening workout when feeling positively energized.Likewise, we are more

likely to make an enduring friend or social connection when we are initially upbeat and

happy upon first meeting a person.

As the COVID-19 pandemic continues and many of us are sheltering in place,

there is a tremendous strain placed on both us as individuals and our relationships with

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family, roommates, colleagues, and neighbors. These tensions can have long-lasting

effects on our mental health. The good news is that resilience is possible, but it requires

more than just a positive mindset (Michael Ungar,2020).

COVID-19 pandemic has had a major effect on our lives. Many of us are facing

challenges that can be stressful, overwhelming, and cause strong emotions in adults and

children. Public health actions, such as social distancing, are necessary to reduce the

spread of COVID-19, but they can make us feel isolated and lonely and can increase

stress and anxiety. Learning to cope with stress in a healthy way will make you, the

people you care about, and those around you become more resilient.

The COVID-19 global pandemic is in many ways unchartered mental health

territory, but history would suggest that long-term resilience will be the most common

outcome, even for those most directly impacted by the outbreak. 

A new study has concluded that living alone is linked to common mental disorders.

The authors have also identified the main driver of this worrying relationship.Share on

PintereSome common mental disorders (CMDs) include mood disorders, anxiety, and

substance use disorders.According to some studies, almost one-third trust source of

people will experience a CMD in their lifetime.These conditions can have a significant

impact on the individual, of course, but due to their high prevalence, they also affect

society at large.Due to the widespread influence of CMDs, scientists are keen to

understand the full range of risk factors that feed into mental health.In recent years,

scientists have investigated whether living alone might be one such risk factor.A new

study, the results of which now appear in the journal PLOS ONE, takes a fresh look at

this question. The study authors conclude that there is a link between living alone and

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CMDs. They also find that it affects all age groups and sexes, and that primarily,

loneliness is the driver(Tim Newman,2019).

People with mental health conditions are one and a half times more likely to live in

rented housing than general populations, with greater uncertainty about how long they

can remain n their current home. Research by the NHS Confederation, mental health

network and the National Housing Federation found that , compared with general

population, people with mental health conditions are the one and a half times more likely

to live in in rented housing with greater uncertainty about how long they can remain in

their current home.

They are twice as likely to be happy with their housing, and four times as likely to

say that it makes their health worse. Mental ill health is frequently cited as a reason for a

person being admitted , or readmitted, to impatient care.

People with mental health problems are more likely to find themselves in rented

accommodation, social housing , and in poor housing, with damp and mould problems.

Part of this is due to their lower socioeconomic life chances, but the home should also be

seen as a place of sanctuary and poor conditions, precarious tenancies, frequent moves

and nearby antisocial behaviour can exacerbate problems.

Children who have lived in temporary accommodation for over a year are three

times as likely to have a mental health problem, including depression and anxiety,

compared to their peers.

Living in poor housing affects women more than men. Research by NatCen and

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Shelter found mothers were more likely to suffer clinical depression if they lived in bad

housing: 10% of mothers who lived in acutely bad housing were clinically depressed.

As well as diagnosed conditions, many people report that housing costs have had

an adverse effect on their mental. According to Shelter/YouGov poll, 33%( equivalent to

15 million people) says housing costs are causing stress and depression in their family.

25%(equivalent of 12.2 million people) are kept awake at night by the stress paying their

rent or mortgage. 25% say housing costs are causing arguments with their partners and

other family members(Kate Barrington,2020).

According to (Mayo Clinic Staff), the COVID-19 pandemic has likely brought

many changes to how you live you live your life, and with it uncertainty, altered daily

routines, financial pressures and social isolation. You may worry about getting sick, how

long will the pandemic will last, whether you lose your job, and what the future will

bring. Information overload, rumors and misinformation can make your life out of

control and make it unclear what to do.

In the face of the global COVID-19 pandemic, schools have confronted

unprecedented challenges as they moved to quickly shift classes to an online format,

provide equitable access for all students, support teachers’ and students educational

needs, and make plans amidst great uncertainty. The pandemic itself has caused much

worry, stress , and grief. This stressors can cause mental health challenges for anyone

and can cause acute symptoms to appear for people who may experienced preexisting

mental health challenges.

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In this large scales survey of college students in China, acute stress, anxiety and

depressive symptoms are prevalent during the COVID-19 pandemic. Multiple epidemic

and psycho social factors, such as family members being infected, massive media

exposure, low social support, senior year and prior mental health problems were

associated with increase risk of mental health problems. Psycho social support and

mental health services should be provided to those students at risk.

In a simple of hospital staff, subjective feelings of anxiety about one owns health

were related to personality traits, individual experiences of having close acquaintances

infected with COVID-19.

Republic Act No. 11036 known as the “ Philippine Mental Health Act of 2017”

provides a rights-based mental health bill and a comprehensive framework for the

implementation of optional mental health care in the Philippines.

The Philippine Mental Health Act of 2017 has created an environment for the

organization and provision of hospital and community based mental health care the

Philippines while providing specific legislative checks to ensure the rights of patients

receiving mental health care and treatment are protected.

Extended periods of loneliness can deteriorate mental and physical health

outcomes over time, leading to depression, musculoskeletal disorders, and even chronic

disease. Most schools across the country were forced to shut their doors abruptly to

mitigate the spread of the virus. That’s a huge day-to-day adjustment for students, on top

of the shock and fear of COVID-19.(Alexea Gaffney,M.D.2020)

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School routines are important coping mechanisms for young people with mental

health issues. When schools are closed, they lose an anchor in life and their symptoms

could relapse. Social distancing measures can result in social isolation in an abusive

home, with abuse likely exacerbated during this time of economic uncertainty and stress.

It is a need to monitor young’s people mental health status over the long term, and to

study how prolonged school closures, strict social distancing measures, and the pandemic

itself affect the well being of children and adolescents. (Lee, 2020)

COVID-19 pandemic is making a significant negative impact on mental health of

college students. College students who exhibit greater academic and life difficulties may

be particularly vulnerable to higher mental health distress.

The COVID-19 pandemic has been a period of upheaval for college students.

Academic difficulties (the ability to focus on academic work and online learning) were

associated with the increased levels of all mental health burden measures. Many are

worried about their own health, health of their families, or struggling financially, perhaps

making them less focused on academics, and increasing academic difficulties. Struggling

academically with online courses may further exacerbate mental health distress among

students. College support services may have a crucial role in helping students navigate

the life challenges associated with the pandemic may help to improve their mental health.

(Alesander, 2020).

CHAPTER 3

Research Methodology

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Research Design

The descriptive research method is used to investigate the mental health of the

BSED Social Studies students in Jose Rizal Memorial State University Katipunan

Campus in the time of COVID-19 pandemic. The term descriptive research refers to the

type of research question, design and data analysis that will applied to a given topic

(Helen L. Dulok, 1993). Descriptive statistics tells what is, while inferential statistics to

determine cause and effect. The type of question asked by the researcher will ultimately

determine the type of approach necessary to complete an accurate assessment of the topic

at hand. The main goal of this type of research is to describe the data and characteristics

about what is being studied. The idea behind this type of research is to study frequency,

averages and other statistical calculations. This method is helpful to this study to

determine what mental health issues is experienced by the students during this time of

pandemic.

Research Settings (Map Presentation)

We conducted this study to determine the mental health status of the students. The study

will be conducted in Jose Rizal Memorial State University Katipunan Campus, Brgy.

Dos, Katipunan, Zamboanga del Norte. All students, from First Year to Fourth Year,

taking Bachelor of Secondary Education major in Social Studies for the SY 2020- 2021

will be stratified for a simple random method.

Jose Rizal Memorial State University- Katipunan (JRMSU-Katipunan) is a public

satellite campus part of the Jose Rizal Memorial State University system. Formerly, the

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Katipunan National Agricultural School, the campus was integrated into the system in

2002 along with the Tampilisan Campus.

Presently, the campus is composed of four colleges that offer academic degree

programs in the fields of Teacher Education, Business Management, Arts and Sciences,

and Agriculture. The campus also has a Senior High School program with Academic and

Technical-Vocational Livelihood tracks.

Determination of Sample Size

This study used the purpoSive sampling in which reSearcher WILL SELECT 50

STUDENTS FROM BACHELOR OF SECONDARY EDUCATION MAJOR IN

SOCIAL STUDIES. This research survey conducted on first year, second year, third year

and fourth year college Bachelor of Secondary Students major in Social Studies.

Sampling Design and Technique

The study will use simple random sampling in determining the samples of the

study. 50 STUDENTS OF the Bachelor of Secondary Education major in Social Studies

students of Jose Rizal Memorial State University- Katipunan Campus will be the

respondents of this study.

The study will use simple random sampling in determining the samples of the

study. 50 STUDENTS OF the Bachelor of Secondary Education major in Social Studies

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students of Jose Rizal Memorial State University- Katipunan Campus will be the

respondents of this study.

Description of the Respondents of the Study

The respondents of our study are the selected Bachelor of Secondary Education

major in Social Studies students of Jose Rizal Memorial State University. They are the

one who have enough knowledge to answer the problem posed in our study. They are

described according to their demographic profile such as sex (male and female), and year

BSED SS1, BSED SS2, BSED SS3 and BSED SS4th year.

The Research Instrument

A questionnaire was used in gathering data. The questionnaire has 2 parts. The

questionnaire consisted of items that determined the mental health issues of the students

during the pandemic.

Data Gathering Procedure

The researcher asked the permission to conduct a survey to Jose Rizal Memorial

State University- Katipunan Campus to determine the mental health issues of the

students in time of Corona Virus (COVID-19). The questionnaire was distributed to the

respondents online. Soft copies of the approved questionnaire were distributed in each

group chat in order to gather the relevant data. The collective data were retrieved through

online after they were finished answering.

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BIBLIOGRAPHY

https://www.health.com/article/mental-health-affects-of-covid-19-on-students

https://pubmed.ncbi.nlm.nih.gov/32805704/

https://www.jaci-inpractice.org/article/S2213-2198%2817%2930970-4/abstract

https://journals.sagepub.com/doi/full/10.1177/0020764020915212

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102633/

https://pubmed.ncbi.nlm.nih.gov/30865713

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3170771/

https://link.springer.com/article/10.1007/s00787-020-01630-4

https://pubmed.ncbi.nlm.nih.gov/17721958/

https://journals.sagepub.com/doi/full/10.1177/0706743716651832

https://www.ncbi.nml.nih.gov/pmc/articles/PMC3122271/#:~TEXT=These
%20tendencies%20are%20far%20too,flee%2C%20attack%2C%20or%20spit.

https://pubmed.ncbi.nml.nih.gov/31806473/

https://www.jaci-inpractice.org/article/S2213-2198%2817%2930970-4/fulltext

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