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Comparison of Anxiety and Depression Rates among LGBTQ College Students before and during the Covid-19 Pandemic

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Title: Comparison of Anxiety and Depression Rates among LGBTQ College Students before and during the Covid-19 Pandemic
Language: English
Authors: Benjamin Parchem (ORCID 0000-0002-4800-1884), Adam Wheeler, Amber Talaski, Sherry Davis Molock (ORCID 0000-0002-5901-0145)
Source: Journal of American College Health. 2024 72(1):31-39.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 9
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: College Students, LGBTQ People, Anxiety, Depression (Psychology), COVID-19, Mental Health, Stress Variables
DOI: 10.1080/07448481.2021.2013238
ISSN: 0744-8481
1940-3208
Abstract: Objective: To compare rates of anxiety and depression among LGBTQ college students before and during the COVID-19 pandemic and examine pandemic-related stressors and protective factors. Participants: Two cohorts of LGBTQ college students, aged 18-25, sampled before (N = 3,484) and during (N = 1,647) the pandemic. Methods: The Healthy Minds Study (HMS) is an annual mental health survey administered to college students in the United States, which included additional items related to the COVID-19 pandemic. Results: Mean anxiety symptoms were significantly lower mid-pandemic compared to pre-pandemic, but no differences in mean depressive symptoms were detected. Results varied by sexual and gender minority status. Financial stress, pandemic-related concerns, and witnessing discrimination were risk factors while academic persistence, positive mental health, and formal support were protective factors. Conclusions: Mental health and instrumental support from institutions will be critical for college students during the pandemic. Affirming and empowering spaces for LGBTQ college students may leverage protective factors.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1408098
Database: ERIC
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  Value: <anid>AN0174908838;acl01jan.24;2024Jan23.02:22;v2.2.500</anid> <title id="AN0174908838-1">Comparison of anxiety and depression rates among LGBTQ college students before and during the COVID-19 pandemic </title> <p>To compare rates of anxiety and depression among LGBTQ college students before and during the COVID-19 pandemic and examine pandemic-related stressors and protective factors. Two cohorts of LGBTQ college students, aged 18–25, sampled before (N = 3,484) and during (N = 1,647) the pandemic. The Healthy Minds Study (HMS) is an annual mental health survey administered to college students in the United States, which included additional items related to the COVID-19 pandemic. Mean anxiety symptoms were significantly lower mid-pandemic compared to pre-pandemic, but no differences in mean depressive symptoms were detected. Results varied by sexual and gender minority status. Financial stress, pandemic-related concerns, and witnessing discrimination were risk factors while academic persistence, positive mental health, and formal support were protective factors. Mental health and instrumental support from institutions will be critical for college students during the pandemic. Affirming and empowering spaces for LGBTQ college students may leverage protective factors.</p> <p>Keywords: College students; COVID-19; LGBTQ; mental health</p> <p>In the spring of 2020, the COVID-19 pandemic took root in the United States. Within a few months the United States had experienced 1.7 million confirmed cases and over 100,000 COVID-19-related deaths.[<reflink idref="bib1" id="ref1">1</reflink>] By early May 2021, according to the most recent data available, the United States had experienced over 32 million confirmed cases of COVID-19, resulting in over 570,000 COVID-19-related deaths.[<reflink idref="bib2" id="ref2">2</reflink>] The pandemic has had a deleterious impact on mental health, contributing to experiences of depression, fear, and anxiety.[<reflink idref="bib3" id="ref3">3</reflink>] Public health guidelines such as social distancing may result in feelings of isolation and disconnection from important relationships including family, friends and other critical sources of support.[<reflink idref="bib3" id="ref4">3</reflink>],[<reflink idref="bib4" id="ref5">4</reflink>]</p> <p>Coping with the COVID-19 pandemic may be especially burdensome for college students for reasons related to their unique physical and social contexts, as well as their transition from adolescence to early adulthood. The status quo of postsecondary education in the United States was upturned by the COVID-19 pandemic and institution's responses to the COVID-19 pandemic varied widely. Many colleges and universities acted swiftly to mitigate the impact of COVID-19 while attempting to maintain a semblance of institutionalized pedagogy. Some students were forced to evacuate their campus residences and routines, others asked to quarantine in place, either outcome producing unique risks and consequences.[<reflink idref="bib3" id="ref6">3</reflink>]</p> <p>Adapting to these many simultaneous changes may involve unique challenges to the mental health and well-being of students such as managing academic expectations, creating and reforming social identities, and navigating financial stressors.[<reflink idref="bib5" id="ref7">5</reflink>] According to 2019 data from the National College Health Assessment (NCHA), nearly half (45%) of undergraduate students reported "feeling so depressed it was difficult to function" in the past year.[<reflink idref="bib6" id="ref8">6</reflink>] The average age of college entry coincides with the onset of most lifetime mental disorders, which often present by the age of 25.[<reflink idref="bib7" id="ref9">7</reflink>] The presence of such a disorder increases one's risk of attempting suicide at least threefold, and potentially up to ninefold.[<reflink idref="bib8" id="ref10">8</reflink>],[<reflink idref="bib9" id="ref11">9</reflink>] This risk is exacerbated among lesbian, gay, bisexual, transgender, and queer identified (LGBTQ) youth. Research consistently reports mental health disparities among LGBTQ persons compared to their heterosexual, cisgender counterparts,[[<reflink idref="bib10" id="ref12">10</reflink>], [<reflink idref="bib12" id="ref13">12</reflink>]] partly due to structural inequities in access to mental health care.</p> <p>The multiple minority stress model suggests that college students from the LGBTQ community might be particularly vulnerable to mental health challenges during the pandemic because the stressors related to COVID-19 faced by the general population (e.g., social distancing, personal safety, finances) are compounded by stressors associated with being members of sexual or gender minority groups.[<reflink idref="bib14" id="ref14">14</reflink>],[<reflink idref="bib15" id="ref15">15</reflink>] In addition to the universal pandemic-related stressors, LGBTQ students faced unique stressors associated with returning home to families and/or communities that might be less affirming of their LGBTQ sexual and/or gender identities.[<reflink idref="bib3" id="ref16">3</reflink>],[<reflink idref="bib16" id="ref17">16</reflink>],[<reflink idref="bib17" id="ref18">17</reflink>] LGBTQ students may also perceive fewer barriers to mental health services at their colleges and universities[<reflink idref="bib18" id="ref19">18</reflink>],[<reflink idref="bib19" id="ref20">19</reflink>] and having to relocate to their home communities may remove an important protective factor against poor mental health.[<reflink idref="bib3" id="ref21">3</reflink>],[<reflink idref="bib17" id="ref22">17</reflink>],[<reflink idref="bib20" id="ref23">20</reflink>] For example, in one study, over 60% of students who reported having sought treatment expressed increased difficulty in procuring mental health care between March and May of 2020.[<reflink idref="bib21" id="ref24">21</reflink>] As a result of these stressors and limited access to formal and informal systems of support, it is likely that LGBTQ students are experiencing elevations in mental health challenges in the context of COVID-19.</p> <hd id="AN0174908838-2">Present study</hd> <p>The current study used data from a national mental health survey of college students in the United States to explore differences in LGBTQ college students' rates of anxiety and depression before and during the pandemic. We hypothesized that LGBTQ college students are experiencing higher rates of anxiety and depression during the COVID-19 pandemic as compared to before the pandemic. An additional aim of the study was to explore COVID-19-related stressors and protective factors that may be associated with anxiety and depression symptoms among LGBTQ college students. Due to the exploratory nature of these analyses, no specific hypotheses were formed regarding COVID-19-related stressors and protective factors.</p> <hd id="AN0174908838-3">Methods</hd> <p></p> <hd id="AN0174908838-4">Participants</hd> <p>Participants included two cohorts of LGBTQ college students. Inclusion criteria for the current study included: (<reflink idref="bib1" id="ref25">1</reflink>) enrolled in an undergraduate or graduate program at a participating college or university in the United States, (<reflink idref="bib2" id="ref26">2</reflink>) aged 18–25 years old, and (<reflink idref="bib3" id="ref27">3</reflink>) self-identified as a sexual (i.e., lesbian, gay, bisexual, queer) or gender (i.e., transgender, genderqueer, genderfluid, nonbinary) minority. The primary study sample included 1,647 LGBTQ college students who completed the survey after the start of the COVID-19 pandemic in the United States during the semester of Spring 2020. In order to offer a comparison group to the Spring 2020 cohort with respect to rates of anxiety and depression, 3,484 LGBTQ 18–25-year-old college students were included from the Spring 2019 cohort.</p> <hd id="AN0174908838-5">Study design</hd> <p>The Healthy Minds Study (HMS) is an annual survey examining mental health, service utilization, and related factors among college students administered by the Healthy Minds Network (HMN). HMN collaborates with academic institutions to administer HMS among student populations via an online Qualtrics survey. HMS has received Institutional Review Board (IRB) approval at its primary study site, the University of Michigan, and holds a Certificate of Confidentiality from the National Institute of Health.</p> <p>Following the advent of the COVID-19 pandemic, HMN collaborated with the NCHA to develop questions related to COVID-19. In total, seven academic institutions participated in HMS and utilized the COVID-19 questions. These seven institutions, which vary in size, institutional type, and geography (Connecticut, Florida, Massachusetts, Michigan, New York, Virginia, and Washington) were compared to the 34 institutions that participated in HMS in Spring 2019. In general, institutions do not participate in HMS every academic year, so there was no overlap in institutions between Spring 2019 and Spring 2020, but the samples had similar variability in school size, institution type, and region.</p> <p>In the Spring 2019 cohort, the average response rate across the 42 institutions was 17.8%. The majority of schools in this cohort sampled only a portion of their students, typically around 4,000 in total. In the Spring 2020 cohort, three institutions sampled their entire population, while the other four randomly selected a portion of their students to be sampled. The average response rate across the seven institutions in Spring 2020 was 8.9%.</p> <hd id="AN0174908838-6">Measures</hd> <p></p> <hd id="AN0174908838-7">Anxiety</hd> <p>The Generalized Anxiety Disorder 7-Item (GAD-7) scale assesses anxiety symptoms within the past two weeks, using a four-point frequency scale ranging from 0 (not at all) to 3 (nearly every day).[<reflink idref="bib22" id="ref28">22</reflink>] Scores on the GAD-7 range from 0 to 21. A cutoff score of 10, with some degree of difficulty in functioning, is used when screening for an anxiety disorder.[<reflink idref="bib23" id="ref29">23</reflink>] Other diagnostic cutoffs are used to differentiate between symptom severity levels: mild (<reflink idref="bib5" id="ref30">5</reflink>), moderate (<reflink idref="bib10" id="ref31">10</reflink>), severe (<reflink idref="bib15" id="ref32">15</reflink>). In our sample, the GAD-7 had a Cronbach's alpha of 0.90.</p> <hd id="AN0174908838-8">Depression</hd> <p>The Patient Health Questionnaire-9 (PHQ-9) scale is a 9-item self-report measure that assesses depressive symptoms within the past two weeks. PHQ-9 scores range from 0 to 27, measured on a frequency scale: 0 (not at all) to 3 (nearly every day).[<reflink idref="bib24" id="ref33">24</reflink>] A positive screen for a depressive disorder includes a score of 10 or higher and some degree of difficulty in functioning.[<reflink idref="bib25" id="ref34">25</reflink>] The PHQ-9 can also serve as a severity measure; minimal (0–4), mild (5–9), moderate (10–14), moderately severe (15–19) and severe depression (20–27).[<reflink idref="bib24" id="ref35">24</reflink>] In our sample, the PHQ-9 had a Cronbach's alpha of 0.88.</p> <hd id="AN0174908838-9">COVID-19-related stressors</hd> <p>In light of the COVID-19 pandemic, a series of questions were added to the Spring 2020 HMS survey. One item assessed how the students' financial situations had been affected as a result of the pandemic on a five-point continuous scale, with response options ranging from 1 (a lot less stressful) to 5 (a lot more stressful). Students were also asked if they had to move to a new living situation as a result of the pandemic (yes/no). A series of questions assessed students' concerns in the past two weeks related to the COVID-19 pandemic including how long the pandemic will last, how many more people will become infected with COVID-19, their personal sense of safety, if they will personally contract COVID-19, and if people they care about will contract COVID-19. Each of these items was on a five-point response scale ranging from 1 (not at all concerned) to 5 (extremely concerned). Lastly, students were asked two separate questions related to discrimination. One item assessed if the student had experienced any discriminatory or hostile behavior due to race/ethnicity as a result of the COVID-19 pandemic (yes/no). The other item assessed if the student had witnessed any discriminatory or hostile behavior due to race/ethnicity as a result of the COVID-19 pandemic, and if so, what was the race/ethnicity of the victim.</p> <hd id="AN0174908838-10">Protective factors</hd> <p>Multiple protective factors were assessed in the HMS survey of student mental health in light of COVID-19. Academic persistence was assessed using a single item "I am confident that I will be able to finish my degree no matter what challenges I may face" with a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Positive mental health was assessed using the Diener Flourishing Scale, an 8-item self-report measure of an individual's perceived success in various facets of life including self-esteem, purpose, relationships and optimism.[<reflink idref="bib26" id="ref36">26</reflink>] Higher scores are indicative of greater flourishing. Self-report of current utilization of therapeutic services was also assessed by a dichotomous (yes/no) survey item asking, "Are you currently receiving counseling or therapy?" Informal social support was measured by a single item which asked respondents to identify people in their life who support their emotional health including roommates, friends, partners, family members, and religious groups. This item was dichotomized for analyses (0 = no sources of informal support; 1 = at least one source of informal support). Formal support was included with the COVID-19 supplemental questions which assessed student's perceived supportiveness from their university's administration, their professors, their campus mental health services, and their campus medical services during the COVID-19 pandemic. Response options were on a five-point continuous scale from 1 (very unsupportive) to 5 (very supportive).</p> <hd id="AN0174908838-11">Statistical analyses</hd> <p>All analyses were performed in SAS 9.4. Descriptive statistics were conducted to identify sociodemographic characteristics of students and measure the impact of COVID-19-related stressors and protective factors. To adjust for potential differences between responders and non-responders, sample probability weights were constructed based on administrative data from participating institutions, including gender, race/ethnicity, academic level, and grade point average. These data were used to construct weights, equal to 1 divided by the estimated probability of response such that weights were larger for respondents with underrepresented characteristics to reflect the full population. Mean anxiety and depressive symptom totals were compared using independent samples <emph>t</emph>-tests, including comparisons within sexual and gender minority statuses. A Bonferroni adjusted <emph>p</emph>-value of 0.005 was used for all <emph>t</emph>-tests (alpha.05/10 comparisons), per dependent variable (GAD7 total and PHQ9 total). Effect sizes (Cohen's <emph>d</emph>) were calculated by subtracting the GAD-7 and PHQ-9 means for Spring 2020 and Spring 2019 samples and dividing by the pooled standard deviation.[<reflink idref="bib27" id="ref37">27</reflink>] All continuous variables were standardized to a mean of zero and a standard deviation of one. Simple linear regressions were conducted between continuous COVID-19-related stressors (ie, financial stress, pandemic-related concerns), protective factors (academic persistence, positive mental health, and formal support), and anxiety and depression symptom totals from the GAD-7 and PHQ-9. For discrete COVID-19-related stressors (moving, discrimination) and protective factors (therapy, informal support), analyses of variance (ANOVAs) were conducted to examine group differences in the anxiety and depression symptom totals. Analyses controlled for gender and race.</p> <hd id="AN0174908838-12">Results</hd> <p></p> <hd id="AN0174908838-13">Sample demographics</hd> <p>Weighted descriptive statistics were computed separately for each cohort and are displayed in Table 1. For the Spring 2020 cohort of LGBTQ college students, the mean age was 20.8 years with approximately 57% self-identified as cisgender women and 9% as gender diverse people (i.e., genderqueer, gender nonbinary, genderfluid). Nearly half (45%) of the students self-identified as bisexual, followed by gay (14%), questioning (14%), queer (13%), and lesbian (6%). The majority of students were White (56%), followed by multiracial/other races (14%), Asian American (13%), Hispanic/Latino (9%), and Black (6%). Students were predominately seeking a bachelor's degree. Roughly half the students reported some level of financial stress while growing up and over 70% reported financial stress at the time of data collection. For reference, the Spring 2019 cohort of LGBTQ college students was demographically similar to the Spring 2020 cohort (see Table 1).</p> <p>Table 1. Sociodemographic characteristics of LGBTQ college student samples.</p> <p> <ephtml> <table><thead><tr><td>Characteristic</td><td>Spring 2019 (<italic>N</italic> = 3,484)</td><td>Spring 2020 (<italic>N</italic> = 1,647)</td></tr></thead><tbody valign="top"><tr><td>Age (Mean (SD))</td><td char=".">20.41 (2.15)</td><td char=".">20.81 (1.51)</td></tr><tr><td>Gender (%)</td><td /><td /></tr><tr><td> Man</td><td char=".">25.9</td><td char=".">33.4</td></tr><tr><td> Woman</td><td char=".">63.4</td><td char=".">57.2</td></tr><tr><td> Gender diverse (Transgender, Genderqueer, Genderfluid, Non-binary)</td><td char=".">10.7</td><td char=".">9.4</td></tr><tr><td>Sexual orientation (%)</td><td /><td /></tr><tr><td> Lesbian</td><td char=".">6.9</td><td char=".">5.6</td></tr><tr><td> Gay</td><td char=".">10.8</td><td char=".">14.4</td></tr><tr><td> Bisexual</td><td char=".">43.6</td><td char=".">45.4</td></tr><tr><td> Queer</td><td char=".">21.9</td><td char=".">12.8</td></tr><tr><td> Questioning</td><td char=".">8.4</td><td char=".">13.9</td></tr><tr><td> Asexual</td><td char=".">4.1</td><td char=".">4.0</td></tr><tr><td> Demisexual</td><td char=".">0.7</td><td char=".">0.8</td></tr><tr><td> Pansexual</td><td char=".">3.6</td><td char=".">3.1</td></tr><tr><td>Race/ethnicity (%)</td><td /><td /></tr><tr><td> African American/Black</td><td char=".">6.5</td><td char=".">6.2</td></tr><tr><td> Asian American</td><td char=".">8.4</td><td char=".">12.7</td></tr><tr><td> Hispanic/Latino</td><td char=".">7.1</td><td char=".">8.8</td></tr><tr><td> Middle Eastern or Arab</td><td char=".">0.9</td><td char=".">1.7</td></tr><tr><td> Multiracial/Other</td><td char=".">15.4</td><td char=".">14.3</td></tr><tr><td> White</td><td char=".">61.7</td><td char=".">56.3</td></tr><tr><td>Degree seeking (%)</td><td /><td /></tr><tr><td> Associate's</td><td char=".">17.6</td><td char=".">2.9</td></tr><tr><td> Bachelor's</td><td char=".">76.0</td><td char=".">76.3</td></tr><tr><td> Master's</td><td char=".">4.5</td><td char=".">13.7</td></tr><tr><td> Doctorate's (PhD, MD, JD, DVM)</td><td char=".">1.9</td><td char=".">7.1</td></tr><tr><td>Socioeconomic background (%)</td><td /><td /></tr><tr><td> Financial stress in childhood</td><td char=".">59.5</td><td char=".">56.7</td></tr><tr><td> Current financial stress</td><td char=".">78.8</td><td char=".">70.3</td></tr></tbody></table> </ephtml> </p> <hd id="AN0174908838-14">Rates of anxiety and depression between two cohorts</hd> <p>The comparison of rates of anxiety and depression between the two cohorts of students is available in Table 2, including comparisons within sexual and gender minority statuses. Rates of anxiety (48% vs. 46%) and depression (61% vs. 58%) were higher among the Spring 2020 cohort compared to the Spring 2019 cohort. The mean anxiety symptom total was significantly lower in the Spring 2020 cohort (<emph>t</emph> = 3.24, <emph>p</emph> <.001, <emph>d</emph> =.10). There was no significant difference between mean depressive symptom totals. Among specific sexual and gender minority statuses, rates of anxiety and depression differed. Regarding anxiety, men were the only group of students who reported a higher mean anxiety symptoms total during the pandemic (<emph>t</emph>= −3.38, <emph>p</emph> <.001, <emph>d</emph> =.19). Women (<emph>t</emph> = 4.66, <emph>p</emph> <.001, <emph>d</emph> =.18), gender diverse students (<emph>t</emph> = 4.95, <emph>p</emph> <.001, <emph>d</emph> =.48), and bisexual students (<emph>t</emph> = 3.34, <emph>p</emph> <.001, <emph>d</emph> =.15) reported a lower mean anxiety symptoms total during the pandemic. Regarding depression, men (<emph>t</emph>= −4.09, <emph>p</emph> <.001, <emph>d</emph> =.23) and lesbian and gay students (<emph>t</emph>= −2.45, <emph>p</emph> <.005, <emph>d</emph> =.18) reported a higher mean depressive symptoms total during the pandemic. Gender diverse students (<emph>t</emph> = 4.35, <emph>p</emph> <.05, <emph>d</emph> =.28) experienced a lower mean depressive symptoms total during the pandemic.</p> <p>Table 2. Rates of anxiety and depression between two cohorts.</p> <p> <ephtml> <table><thead><tr><td /><td>GAD7 Total (mean (SD))</td><td /><td>Screened positive (%)</td><td>Mild (%)</td><td>Moderate (%)</td><td>Severe (%)</td><td>PHQ9 Total (mean (SD))</td><td /><td>Screened Positive (%)</td><td>Mild (%)</td><td>Moderate (%)</td><td>Moderately Severe (%)</td><td>Severe (%)</td></tr></thead><tbody valign="top"><tr><td /><td>Pre</td><td>Mid</td><td><italic>t</italic>-value/effect size (<italic>d</italic>)</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td><td><italic>t</italic>-value/effect size (<italic>d</italic>)</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mild</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td><td>Pre</td><td>Mid</td></tr><tr><td>Total</td><td char=".">9.91 (6.95)</td><td char=".">9.34 (4.52)</td><td char=".">3.24*/0.10</td><td char=".">47.6</td><td char=".">45.7</td><td char=".">27.5</td><td char=".">27.1</td><td char=".">22.4</td><td char=".">23.8</td><td char=".">25.2</td><td char=".">21.9</td><td char=".">11.97 (7.75)</td><td char=".">12.19 (5.05)</td><td char=".">−1.13/0.03</td><td char=".">58.0</td><td char=".">60.6</td><td char=".">21.7</td><td char=".">20.8</td><td char=".">24.7</td><td char=".">23.9</td><td char=".">18.0</td><td char=".">21.6</td><td char=".">15.3</td><td char=".">15.0</td></tr><tr><td>Man</td><td char=".">8.01 (7.76)</td><td char=".">9.35 (6.05)</td><td char=".">−3.38**/0.19</td><td char=".">34.5</td><td char=".">46.1</td><td char=".">27.8</td><td char=".">28.6</td><td char=".">18.6</td><td char=".">23.5</td><td char=".">15.9</td><td char=".">22.6</td><td char=".">10.18 (8.56)</td><td char=".">11.97 (6.60)</td><td char=".">−4.09**/0.23</td><td char=".">44.2</td><td char=".">61.4</td><td char=".">23.9</td><td char=".">19.1</td><td char=".">22.6</td><td char=".">25.5</td><td char=".">11.4</td><td char=".">23.9</td><td char=".">10.1</td><td char=".">12.0</td></tr><tr><td>Woman</td><td char=".">10.38 (6.45)</td><td char=".">9.42 (4.00)</td><td char=".">4.66**/0.18</td><td char=".">50.4</td><td char=".">46.5</td><td char=".">28.3</td><td char=".">25.4</td><td char=".">23.1</td><td char=".">24.4</td><td char=".">27.3</td><td char=".">22.0</td><td char=".">12.17 (7.19)</td><td char=".">12.34 (4.49)</td><td char=".">−0.73/0.03</td><td char=".">60.6</td><td char=".">60.6</td><td char=".">21.5</td><td char=".">22.5</td><td char=".">25.8</td><td char=".">23.6</td><td char=".">20.1</td><td char=".">20.1</td><td char=".">14.8</td><td char=".">17.0</td></tr><tr><td>Gender Diverse</td><td char=".">11.73 (7.12)</td><td char=".">8.84 (4.78)</td><td char=".">4.95**/0.48</td><td char=".">62.7</td><td char=".">39.3</td><td char=".">22.4</td><td char=".">32.0</td><td char=".">27.5</td><td char=".">21.2</td><td char=".">35.2</td><td char=".">18.1</td><td char=".">15.04 (8.21)</td><td char=".">12.03 (5.72)</td><td char=".">4.35**/0.43</td><td char=".">75.2</td><td char=".">57.6</td><td char=".">17.3</td><td char=".">17.2</td><td char=".">22.9</td><td char=".">20.5</td><td char=".">21.3</td><td char=".">22.9</td><td char=".">31.0</td><td char=".">14.2</td></tr><tr><td>Lesbian/Gay</td><td char=".">8.82 (7.20)</td><td char=".">8.79 (4.76)</td><td char=".">0.08/0.01</td><td char=".">41.2</td><td char=".">42.2</td><td char=".">26.0</td><td char=".">32.8</td><td char=".">21.6</td><td char=".">25.4</td><td char=".">19.7</td><td char=".">16.9</td><td char=".">10.45 (7.73)</td><td char=".">11.64 (5.76)</td><td char=".">−2.45*/0.18</td><td char=".">48.4</td><td char=".">60.8</td><td char=".">24.8</td><td char=".">16.9</td><td char=".">25.0</td><td char=".">24.9</td><td char=".">13.0</td><td char=".">24.0</td><td char=".">10.4</td><td char=".">11.9</td></tr><tr><td>Bisexual</td><td char=".">10.18 (7.06)</td><td char=".">9.32 (4.37)</td><td char=".">3.34**/0.15</td><td char=".">48.9</td><td char=".">45.3</td><td char=".">27.1</td><td char=".">27.2</td><td char=".">21.6</td><td char=".">23.1</td><td char=".">27.3</td><td char=".">22.2</td><td char=".">12.19 (8.05)</td><td char=".">12.23 (4.89)</td><td char=".">−0.12/0.01</td><td char=".">58.6</td><td char=".">59.5</td><td char=".">20.6</td><td char=".">23.4</td><td char=".">24.1</td><td char=".">24.6</td><td char=".">17.5</td><td char=".">18.8</td><td char=".">17.0</td><td char=".">16.1</td></tr><tr><td>Queer/Questioning</td><td char=".">10.12 (6.67)</td><td char=".">9.741 (4.77)</td><td char=".">1.19/0.07</td><td char=".">48.7</td><td char=".">47.5</td><td char=".">29.5</td><td char=".">23.5</td><td char=".">22.9</td><td char=".">22.5</td><td char=".">25.7</td><td char=".">25.0</td><td char=".">12.28 (7.26)</td><td char=".">12.32 (5.03)</td><td char=".">−0.11/0.01</td><td char=".">60.0</td><td char=".">60.4</td><td char=".">23.7</td><td char=".">20.1</td><td char=".">24.5</td><td char=".">21.2</td><td char=".">20.1</td><td char=".">23.5</td><td char=".">15.4</td><td char=".">15.7</td></tr><tr><td>Asexual</td><td char=".">8.90 (6.58)</td><td char=".">9.43 (3.97)</td><td char=".">−0.68/0.10</td><td char=".">42.8</td><td char=".">52.0</td><td char=".">27.1</td><td char=".">20.8</td><td char=".">23.3</td><td char=".">26.6</td><td char=".">19.6</td><td char=".">25.4</td><td char=".">12.23 (7.47)</td><td char=".">12.79 (4.91)</td><td char=".">−0.59/0.09</td><td char=".">61.5</td><td char=".">65.3</td><td char=".">18.1</td><td char=".">14.2</td><td char=".">25.0</td><td char=".">18.7</td><td char=".">22.5</td><td char=".">33.0</td><td char=".">14.0</td><td char=".">13.6</td></tr><tr><td>Demisexual</td><td char=".">9.41 (6.28)</td><td char=".">9.74 (3.39)</td><td char=".">−0.20/0.07</td><td char=".">59.6</td><td char=".">62.4</td><td char=".">18.4</td><td char=".">21.2</td><td char=".">42.4</td><td char=".">57.2</td><td char=".">17.2</td><td char=".">5.1</td><td char=".">10.94 (7.96)</td><td char=".">13.09 (3.87)</td><td char=".">−1.10/0.34</td><td char=".">55.3</td><td char=".">60.7</td><td char=".">14.9</td><td char=".">39.3</td><td char=".">24.3</td><td char=".">18.2</td><td char=".">20.1</td><td char=".">25.6</td><td char=".">10.9</td><td char=".">17.0</td></tr><tr><td>Pansexual</td><td char=".">11.49 (6.34)</td><td char=".">9.80 (4.25)</td><td char=".">1.86/0.31</td><td char=".">58.7</td><td char=".">44.6</td><td char=".">25.8</td><td char=".">29.5</td><td char=".">26.6</td><td char=".">23.3</td><td char=".">32.1</td><td char=".">21.4</td><td char=".">13.93 (7.20)</td><td char=".">12.91 (4.60)</td><td char=".">1.01/0.17</td><td char=".">77.3</td><td char=".">70.9</td><td char=".">7.5</td><td char=".">19.1</td><td char=".">31.1</td><td char=".">39.0</td><td char=".">25.9</td><td char=".">15.8</td><td char=".">20.3</td><td char=".">16.1</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note. *p</emph> <.005; <emph>**p</emph> <.001. "Pre" columns refer to the Spring 2019 cohort (pre-COVID-19 pandemic) and the "Mid" columns refer to the Spring 2020 cohort (mid-COVID-19 pandemic).</p> <p>The proportion of students who fell into different symptom severity ranges for anxiety and depression were fairly similar. For anxiety, Spring 2020 students were similarly represented in the mild symptom range, more represented in the moderate symptom range, and less represented in the severe symptom range. For depression, Spring 2020 students were less represented in the mild and moderate symptom ranges, more represented in the moderately severe symptom range, and similarly represented in the severe symptom range.</p> <hd id="AN0174908838-15">COVID-19-related stressors and protective factors</hd> <p>The Spring 2020 cohort endorsed significant stressors as a result of the COVID-19 pandemic as well as several protective factors; see Table 3 for weighted frequencies. While very few students reported testing positive for COVID-19 (0.1%), 17% reported COVID-19 symptoms. The majority of students (68%) reported financial stress related to the pandemic and about half of the students (46%) moved as a result of the pandemic. On a scale from 1 (not at all concerned) to 5 (extremely concerned), students indicated the most concern for how long the pandemic will last (<emph>M</emph> = 4.1, <emph>SD</emph> = 0.7) and loved ones contracting COVID-19 (<emph>M</emph> = 4.0, <emph>SD</emph> = 0.8). Students expressed the least amount of concern for personally contracting COVID-19 (<emph>M</emph> = 2.8, <emph>SD</emph> = 1.0) and personal sense of safety during the pandemic (<emph>M</emph> = 3.1, <emph>SD</emph> = 0.9). The sample was highly persistent toward academics (<emph>M</emph> = 5.0, <emph>SD</emph> = 0.8, range = 1–6) and perceived the most support from professors (<emph>M</emph> = 4.1, <emph>SD</emph> = 0.8, range = 1–5) during the pandemic. A fifth of the students were currently in therapy and approximately 81% reported receiving informal support from friends and family.</p> <p>Table 3. Stressors and protective factors for LGBTQ college students during the COVID-19 pandemic (<emph>N</emph> = 1,647).</p> <p> <ephtml> <table><thead><tr><td /><td>%</td><td>Mean (SD)</td><td>Anxiety</td><td>Depression</td></tr><tr><td><italic>β</italic> or <italic>F</italic><sup>a</sup></td><td><italic>β</italic> or <italic>F</italic><sup>a</sup></td></tr></thead><tbody valign="top"><tr><td>COVID-19 Symptoms (%)</td><td /><td /><td /><td /></tr><tr><td> Yes (tested positive)</td><td char=".">0.1</td><td /><td>–</td><td>–</td></tr><tr><td> Symptomatic (not tested)</td><td char=".">17.0</td><td /><td>–</td><td>–</td></tr><tr><td> No symptoms</td><td char=".">82.9</td><td /><td>–</td><td>–</td></tr><tr><td>COVID-19 stressors</td><td /><td /><td /></tr><tr><td>Financial stress</td><td char=".">68.2</td><td /><td char=".">0.25**</td><td char=".">0.27**</td></tr><tr><td>Moved</td><td char=".">46.1</td><td /><td char=".">1.00<sup>a</sup></td><td char=".">2.94<sup>a</sup></td></tr><tr><td>Concerns for... (range 1–5)</td><td /><td /><td /><td /></tr><tr><td> How long the pandemic will last</td><td /><td char=".">4.1 (0.7)</td><td char=".">0.29**</td><td char=".">0.22**</td></tr><tr><td> How many people will be infected</td><td /><td char=".">3.8 (0.8)</td><td char=".">0.28**</td><td char=".">0.18**</td></tr><tr><td> Personal sense of safety</td><td /><td char=".">3.1 (0.9)</td><td char=".">0.37**</td><td char=".">0.26**</td></tr><tr><td> Personally contracting COVID-19</td><td /><td char=".">2.8 (1.0)</td><td char=".">0.27**</td><td char=".">0.17**</td></tr><tr><td> Loved ones contracting COVID-19</td><td /><td char=".">4.0 (0.8)</td><td char=".">0.26**</td><td char=".">0.19**</td></tr><tr><td>Racial discrimination</td><td /><td /><td /><td /></tr><tr><td> Experienced</td><td char=".">5.5</td><td /><td char=".">3.15<sup>a</sup></td><td char=".">0.49<sup>a</sup></td></tr><tr><td> Witnessed</td><td char=".">61.4</td><td /><td char=".">29.16<sup>a</sup>**</td><td char=".">27.02<sup>a</sup>**</td></tr><tr><td>Protective factors</td><td /><td /><td /></tr><tr><td>Academic persistence (range 1–6)</td><td /><td char=".">5.0 (0.8)</td><td char=".">−0.23**</td><td char=".">−0.36**</td></tr><tr><td>Positive mental health</td><td char=".">18.6</td><td /><td char=".">−0.37**</td><td char=".">−0.52**</td></tr><tr><td>Currently in therapy</td><td char=".">20.0</td><td /><td char=".">16.51<sup>a</sup>**</td><td char=".">3.31<sup>a</sup></td></tr><tr><td>Informal support (friends/family)</td><td char=".">80.8</td><td /><td char=".">11.44<sup>a</sup>**</td><td char=".">6.60<sup>a</sup>*</td></tr><tr><td>Formal support from... (range 1–5)</td><td /><td /><td /><td /></tr><tr><td> College/University administration</td><td /><td char=".">3.6 (0.8)</td><td char=".">−0.20**</td><td char=".">−0.18**</td></tr><tr><td> Professors</td><td /><td char=".">4.1 (0.8)</td><td char=".">−0.18**</td><td char=".">−0.21**</td></tr><tr><td> Campus mental health services</td><td /><td char=".">3.5 (0.8)</td><td char=".">−0.12**</td><td char=".">−0.17**</td></tr><tr><td> Campus medical services</td><td /><td char=".">3.5 (0.8)</td><td char=".">−0.13**</td><td char=".">−0.16**</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note</emph>. <sups>*</sups><emph>p</emph> <.05; <sups>**</sups><emph>p</emph> <.001. <sups>a</sups>Indicates the test-statistic is an <emph>F</emph>-score, otherwise all other test-statistics are parameter estimates (<emph>β</emph>). Anxiety and depression were standardized continuous symptom totals. All analyses controlled for gender and race.</p> <p>Several of the COVID-19-related stressors were associated with anxiety and depression symptom totals in the past two weeks (see Table 3). To note, the proportion of variability in anxiety and depression symptom totals attributed to school attended was negligible (GAD7: <emph>ICC</emph> = 0.002; PHQ9: <emph>ICC</emph> = 0.008). Financial stress was positively associated with both anxiety (<emph>β</emph> = 0.25) and depression (<emph>β</emph> = 0.27) whereas moving due to COVID-19 was not related. Concerns regarding the longevity of the pandemic, the number of people who will become infected with COVID-19, personal safety during the pandemic, personally contracting COVID-19, and loved ones contracting COVID-19 were all positively related to anxiety and depression in the past two weeks (<emph>β</emph> = 0.17 to 0.37). Gender diversity status moderated the relationships between concerns regarding the longevity of the pandemic (<emph>β</emph><subs>interaction</subs> = 0.32), the number of people who will become infected with COVID-19 (<emph>β</emph><subs>interaction</subs> = 0.26), and personally contracting COVID-19 (<emph>β</emph><subs>interaction</subs> = 0.22) with depression such that these factors more strongly predicted higher depression symptom totals for gender diverse students than cisgender students. Experiencing discrimination was not related to anxiety and depression but witnessing discrimination was associated with higher anxiety (<emph>F</emph> = 29.16) and depression (<emph>F</emph> = 27.02) symptom totals.</p> <p>Some of the protective factors were associated with anxiety and depression symptom totals as well (see Table 3). Academic persistence was negatively related to anxiety (<emph>β</emph> = −0.23) and depression (<emph>β</emph> = −0.36). Positive mental health had particularly strong associations with anxiety (<emph>β</emph> = −0.37) and depression (<emph>β</emph> = −0.52). Paradoxically, currently receiving therapy was associated with higher anxiety symptom totals and having informal support from friends and family was associated with higher anxiety and depression symptom totals. Lastly, perceived support from college administrations, professors, campus mental health services, and campus medical services were all negatively related to anxiety and depression (<emph>β</emph> = −0.12 to −0.21). Gender diversity status moderated the relationship between support from college administrators and depression (<emph>β</emph><subs>interaction</subs> = −0.25) such that administrative support more strongly predicted lower depression symptom totals for gender diverse students than cisgender students.</p> <hd id="AN0174908838-16">Discussion</hd> <p>In this study we were interested in examining if the COVID-19 pandemic had a deleterious impact on the mental well-being of college students who are members of the LGBTQ community. The multiple minority stress model suggests that LGBTQ college students might be particularly vulnerable to mental health challenges during the COVID-19 pandemic because the COVID-19 stressors would be compounded by the stress associated with being members of sexual or gender minority groups.</p> <p>The results, in general, did not support our hypothesis that LGBTQ students would experience higher rates of anxiety and depression during the pandemic as compared to before the pandemic. LGBTQ students sampled during the pandemic had higher rates of screening positive for anxiety and depression when compared to a sample of LGBTQ students who were sampled the year prior. On the other hand, mean anxiety symptom totals were lower (small effect size) and mean depression symptom totals were not different during the pandemic. However, this pattern was not uniformly observed across all LGBTQ students; notable differences were identified for specific sexual and gender minority groups. Students who identified as men seem to be at risk of developing an internalizing disorder during the pandemic given their elevated anxiety and depressive symptoms relative to the year prior. This analysis cannot clearly identify why this group of students, which consists of cis sexual minority men, and potentially trans men who did not identify as gender diverse, may be facing greater mental health challenges during the pandemic. However, this analysis does support the need for greater supports for these students. Lesbian and gay students also experienced greater depressive symptoms during the pandemic and may benefit from additional mental health supports. On the other hand, gender diverse students experienced significantly less anxiety and depression during the pandemic, relative to pre-pandemic, which is inconsistent with some of their LGBTQ peers. Trans, nonbinary, and genderqueer students face daily stressors living as their authentic selves in public. The reduction in public interactions and increased time in quarantine may have provided some relief to these daily stressors. This pattern may be better understood by engaging gender diverse students in qualitative research.</p> <p>The reduction in anxiety symptoms and minimal differences in depressive symptoms pre- to mid-pandemic may be a reflection of LGBTQ students' ability to adapt to change and tolerate uncertainty. For many LGBTQ people, living outwardly as a sexual or gender minority in public involves assessing environments for safety cues, disclosing identity to others without definite knowledge of how someone may respond, and evaluating someone's acceptance of sexual and gender diversity in school and workplace environments. It may be that the rehearsal of these demands lends to a greater ability to tolerate uncertainty and cope with frequent change. These results may also be related to the continuity of students' typical stressors (academics, time management, peer and romantic relationships) during the pandemic, and at the time of survey completion, students were not aware of the longevity of quarantine, which may have resulted in less worrying. It is also possible that some LGBTQ students who moved home from campus at the start of the COVID-19 pandemic experienced less stress at home due to fewer social demands, adjusted workloads from professors, and a reduction in responsibilities on campus. Additionally, the sample of LGBTQ students during the pandemic strongly believed in their ability to persist through schooling despite challenges and frequently relied on support systems of family and friends. These factors seemed to protect students from greater anxiety and depressive symptoms.</p> <p>Students, particularly gender diverse students, in the Spring 2020 sample who were concerned about COVID-19-related stressors such as the financial impact of COVID-19, the longevity of the pandemic, and how it might impact the health of loved ones reported higher symptoms of anxiety and depression. Students also expressed concerns about racial discrimination, and those who witnessed discrimination, mostly against Asian Americans, were more likely to report experiencing anxiety and/or depressive symptoms. These relationships support the need to address the mental health needs of LGBTQ students from an intersectional approach, understanding the multiple and intersecting identities of LGBTQ students and how they uniquely interact to contribute to mental wellness and mental health challenges. Additionally, it emphasizes the importance of recognizing potential differences in mental health needs between gender diverse students and sexual minority students, who appear to be impacted by the pandemic differently.</p> <p>Protective factors that seemed to buffer the association between COVID-19 and mental health challenges included both individual factors (eg, academic persistence and positive mental health) and systemic support from college administrators, faculty, and mental health services. Administrative support was especially protective for gender diverse students. These findings suggest that support and encouragement from administrators and faculty may help motivate students through the semester and provide a sense of validation for the stress students are experiencing. Paradoxically, currently receiving therapy and having informal support from friends and family were associated with greater mental health challenges. This finding may reflect that students who experienced greater degrees of anxiety and depression are more likely to be in treatment and/or are more likely to seek help from informal support systems, reflecting a strength in this community's ability to seek help.</p> <p>One of our findings that has been supported in the literature is that students from LGBTQ communities experience high levels of emotional distress, in general. The rates of anxiety (46% vs. 48%) and depression (58% vs. 61%) for both the 2019 and 2020 samples were quite high but are comparable to the data for younger adolescents in the Youth Risk Behavior Survey.[<reflink idref="bib28" id="ref38">28</reflink>] The findings also suggest that students from LGBTQ communities may be facing greater mental health challenges during the pandemic because of the combination of an increase in risk factors and simultaneous reduction of protective factors.</p> <p>For example, the need to socially distance and relocate from campuses that might provide more social support and access to mental health services may be particularly detrimental for LGBTQ college students. Some students may not have disclosed their sexual orientation and/or gender identity to their family and thus may be returning to non-affirming spaces.[<reflink idref="bib17" id="ref39">17</reflink>] Research has clearly shown that LGBTQ youth are at heightened risk for physical harm, parental rejection, homelessness, and suicidality.[[<reflink idref="bib28" id="ref40">28</reflink>], [<reflink idref="bib30" id="ref41">30</reflink>]] The hostile environment that LGBTQ students may face after returning home also renders them "invisible" as they no longer have open and visible representation of their queer community at home. Additionally, college campuses often serve as an affordable entry into mental health services; in this sample, 20% of students reported being in therapy and many noted that they found mental health services, college administrators and faculty to be supportive during the pandemic. With greater barriers to accessing formal support and mental health services, LGBTQ students may be more vulnerable to mental health challenges.</p> <p>LGBTQ students from communities of color may also need additional support as they grapple with the multiple, simultaneously occurring stressors associated with the disproportionate morbidity and mortality from COVID-19, the higher unemployment rate, and the renewed but long-standing problem of racial injustice.[<reflink idref="bib31" id="ref42">31</reflink>] While only a small percentage of students said they personally experienced racism, over half reported witnessing racism, and research indicates that witnessing racism can be traumatizing as well.[<reflink idref="bib32" id="ref43">32</reflink>]</p> <hd id="AN0174908838-17">Implications</hd> <p>Given the challenges that LGBTQ students face during the pandemic, it is critical for university administrators to develop strategies to address the mental health needs of college students in general, but LGBTQ students in particular, while these students continue to adapt to changing formats of instruction and may continue to be socially isolated in homes that may not be supportive of their sexual or gender minority identity or continue to have challenges socially interacting with LGBTQ peers. Institutions of higher learning should consider offering virtual mental health services, particularly as states are beginning to relax licensure requirements so that mental health professionals can provide virtual services across state lines.[<reflink idref="bib33" id="ref44">33</reflink>] Outreach efforts to LGBTQ students from communities of color may be particularly critical as they are doubly marginalized for their gender/sexual identity and race, are less likely to receive mental health services, and more likely to experience homonegativity from their families and communities.[<reflink idref="bib34" id="ref45">34</reflink>],[<reflink idref="bib35" id="ref46">35</reflink>]</p> <p>The findings from this study call for institutions to explore and implement strategies for supporting students from an intersectional lens, given the differences in how gender diverse students and sexual minority students are being impacted by the pandemic. For example, our analyses revealed that LGBTQ students who identify as men are facing impactful mental health challenges during the pandemic and should be considered a target community for mental health and academic support in the upcoming academic year. Additionally, depression among gender diverse students was particularly impacted by concerns related to the pandemic. These differences can inform more targeted approaches to supporting students who fall under the LGBTQ umbrella, such as developing specific pandemic-related support groups for gender diverse students or disseminating more mental health information/resources to departments with a higher proportion of students who are queer men.</p> <p>Colleges and universities can consider using social media platforms, including Tinder, Grindr, Instagram, Facebook and school-centric apps to help students stay socially connected to important campus-based support systems. Providing students with information about LGBTQ-friendly Internet sites, chat rooms, or affinity clubs may be particularly helpful as students can have access to visible spaces that fully embrace and affirm their authentic selves. As institutions begin to return to in-person and hybrid instruction, LGBTQ social groups will be critical for students to reconnect with their communities and find support as they navigate and adjust to the new paradigm of instruction.</p> <p>Additionally, instrumental and structural forms of support will be integral for LGBTQ college students who often hold employment in service industry and front-line positions, which have been highly unstable during the COVID-19 pandemic. Employment support, housing assistance, food resources, and accessible healthcare will promote mental well-being among LGBTQ college students.</p> <hd id="AN0174908838-18">Limitations and future directions</hd> <p>To our knowledge, this study is one of the first to look at how the pandemic specifically impacts students from the LGBTQ community. While the robust sample captures varying geographic regions in the United States, the study did not use a random sample of students in the United States, and the response rate was low (nearly 9%). The response rate for HMS typically is 17.8%, but this data was collected in the atypical context of a global pandemic, and the concomitant stressors associated with the pandemic (rapid shift to virtual learning environment, abrupt relocation for housing, loss of family income) may explain why there was a lower response rate than is typically the case for HMS. Additionally, many participating institutions reported that their students were experiencing screen fatigue and survey burnout. Sample probability weights were applied for known characteristics of the full population to adjust for potential response bias, but there may be differences on unobserved characteristics.</p> <p>The data was also collected at the beginning of the pandemic, when most students did not realize they would not be returning to campus for the fall semester. Longitudinal monitoring of mental health challenges among all college students, but particularly LGBTQ college students, throughout the pandemic will help inform interventions strategies for universities and community resources. Lastly, the cross-sectional nature of the data makes it difficult to make causal inferences about the associations between mental health challenges and COVID-19. The Spring 2019 offered a comparable cohort of students, but longitudinal studies that follow students over the course of the pandemic would help elucidate if there is a causal relationship between the pandemic and mental health challenges.</p> <hd id="AN0174908838-19">Acknowledgments</hd> <p>The authors would like to express their gratitude to participants for their generous contributions to the study during a stressful time. We also thank the Healthy Minds Network for their guidance, consultation, and collaboration on this article.</p> <hd id="AN0174908838-20">Conflict of interest disclosure</hd> <p>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 United States of America and received approval from the Institutional Review Board of University of Michigan.</p> <hd id="AN0174908838-21">Funding</hd> <p>The author(s) reported there is no funding associated with the work featured in this article.</p> <ref id="AN0174908838-22"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> World Health Organization. Coronavirus Disease (COVID-19): Situation Report – 132. https://<ulink href="http://www.who.int/docs/default-source/coronaviruse/situation-reports/20200531-covid-19-sitrep-132.pdf?sfvrsn=d9c2eaef%5f2">www.who.int/docs/default-source/coronaviruse/situation-reports/20200531-covid-19-sitrep-132.pdf?sfvrsn=d9c2eaef%5f2</ulink>. Published 2020. 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  Data: Comparison of Anxiety and Depression Rates among LGBTQ College Students before and during the Covid-19 Pandemic
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  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Benjamin+Parchem%22">Benjamin Parchem</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-4800-1884">0000-0002-4800-1884</externalLink>)<br /><searchLink fieldCode="AR" term="%22Adam+Wheeler%22">Adam Wheeler</searchLink><br /><searchLink fieldCode="AR" term="%22Amber+Talaski%22">Amber Talaski</searchLink><br /><searchLink fieldCode="AR" term="%22Sherry+Davis+Molock%22">Sherry Davis Molock</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5901-0145">0000-0002-5901-0145</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2024 72(1):31-39.
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Data: 9
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  Label: Publication Date
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  Data: 2024
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  Data: Journal Articles<br />Reports - Research
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  Label: Education Level
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  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22LGBTQ+People%22">LGBTQ People</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink>
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  Data: 10.1080/07448481.2021.2013238
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  Data: 0744-8481<br />1940-3208
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  Label: Abstract
  Group: Ab
  Data: Objective: To compare rates of anxiety and depression among LGBTQ college students before and during the COVID-19 pandemic and examine pandemic-related stressors and protective factors. Participants: Two cohorts of LGBTQ college students, aged 18-25, sampled before (N = 3,484) and during (N = 1,647) the pandemic. Methods: The Healthy Minds Study (HMS) is an annual mental health survey administered to college students in the United States, which included additional items related to the COVID-19 pandemic. Results: Mean anxiety symptoms were significantly lower mid-pandemic compared to pre-pandemic, but no differences in mean depressive symptoms were detected. Results varied by sexual and gender minority status. Financial stress, pandemic-related concerns, and witnessing discrimination were risk factors while academic persistence, positive mental health, and formal support were protective factors. Conclusions: Mental health and instrumental support from institutions will be critical for college students during the pandemic. Affirming and empowering spaces for LGBTQ college students may leverage protective factors.
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      – SubjectFull: LGBTQ People
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      – SubjectFull: Anxiety
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      – SubjectFull: Mental Health
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