Quality of life and depressive symptoms among Peruvian university students during the COVID-19 pandemic

Objectives Characterize the quality of life and depressive symptoms of university students in Peru during the COVID-19 pandemic and to determine the associated factors. Methods Multi-centre study in 1634 university students recruited by convenience sampling. Quality of life (QoL) was assessed with the European Quality of Life-5 Dimensions at three levels (EQ-5D-3L) and depressive symptoms with the Patient Health Questionarie-9 (PHQ-9). To evaluate factors associated with QoL and depressive symptoms, linear and adjusted regressions were used, with robust variance reporting coefficients (β). Results The percentage of participants most affected by QoL dimension was: anxiety/depression (47.2%) and pain/discomfort (35.6%). Regarding the Visual Analog Scale (EQ-VAS) of QoL, the score was 76.0 + 25.6. Those who had family economic decline during quarantine (β=-3.4, IC95%=-6.5 to −0.3) or family with chronic diseases (β=-3.7, IC95%=-6.1 to −1.4) presented significantly lower scores in their QoL. Regarding depressive symptomatology, the university students reported a moderate to severe level (28.9%). A higher risk of depressive symptoms was found in residents of Ayacucho (β=0.8, IC95%=0.1 to 1.5), those who were released from quarantine (β=0.7, IC95%=0.2 to 1.2) and those who had a family member with chronic disease (β=1.5, IC95%=1.0 to 2.1). Conclusions Almost half and one third of participants reported anxiety/depression, and pain/discomfort in their QoL respectively. Nearly a third presented moderate and severe depressive symptoms. The deterioration of QoL was worse in those who had a decrease in income and a family member with chronic illness. The presence of depressive symptoms was found in students in Ayacucho, those who left home during quarantine and those who had a family member with chronic diseases.

Introduction 69 deaths (2). In Latin America over 12 million cases of COVID-19 and 400,000 deaths were recorded 70 up to November 2020, making it one of the regions most affected (3).

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The measures to control the spread of COVID-19, such as confinement, have brought about changes 72 in the routine of life of the population that could affect their mental health (4, 5). A recent review study 73 reported prevalences of anxious and depressive symptoms in the population in ranges of 6-50% and 74 14-48% respectively (6). Some factors have been associated with a decline in mental health during 75 the COVID-19 pandemic. For example, people with low economic status, women, and the 76 unemployed have experienced greater mental health problems (7,8). In contrast, a study in China 77 found that the population with depressive symptoms reported a lower quality of life (9). To date, few 78 studies have reported on the COVID-19 pandemic and depressive symptoms and quality of life (QoL) 79 in students despite the fact that the pandemic has severely affected various parts of the world 80 The rapid transmission of COVID-19 led to the suspension of face-to-face academic activities, 81 affecting 91.3% of the world's student population, who had to adapt quickly to non-face-to-face 82 education (10). However, this abrupt transition has led to increased stress, insomnia, anxiety and 83 depression in students, so that their quality of life and mental health may have deteriorated (11)(12)(13).

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Peru reported the first case of COVID-19 on 06 March 2020 and 10 days later a state of national 85 emergency and compulsory social isolation (confinement) was declared (14), but the virus spread 86 rapidly throughout the country. A total of 950, 557 people were infected by 641 87 deaths were recorded in the country as of 24 November 2020 (15).

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The confinement affected the economy of the families and brought anguish to the students of Peru, 89 due to the economic difficulties and digital gaps (connectivity, computers), which caused the 90 government to implement economic policies to the Peruvian families and the education sector such 91 as economic bonds, educational credits, connectivity and scholarships (16)

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The covariates that participated in the study were: age (in tertiles), sex (male or female), department    (Table 3).

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Students residing in the department of Piura and Ayacucho reported lower and higher scores for 278 depressive symptoms than residents of Ancash, respectively. This could be explained by the fact that 279 during the months of evaluation of our study, the rate of COVID-19 infections and deaths in Piura had 280 fallen, while in Ayacucho, a rural area of Peru, it was at its highest peak (53). The score of depressive 281 symptoms was higher in women than in men; this is in line with a recent review study reporting gender 282 differences in depression during . This is probably due to the fact that women are 283 currently having more responsibilities within the work environment and during confinement the family 284 burden (e.g. family caregivers) has increased, generating greater stress and depression(55,56).

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Students who left home during quarantine or had a family member with a chronic illness scored higher 286 on depressive symptoms than those who did not have these characteristics, this finding could be due 287 to the concern about catching and/or infecting at-risk family members during exposure to VOC-19 288 (57).

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The findings in this study suggest the need to implement prevention and intervention strategies to