Impac o COVID-19 on heal h- ela ed quali y
o li e in s uden s and PhD s uden s: a
sys ema ic e iew
Nasie Asipo a1, Sa a Ognyano 2, Emanuil Yo dano 2, Kos adin Angelo 3, Emil H is o 2,
Monika Komi o a4, Valen ina Pe ko a4, S e ka S oyano a2, I a Pa o a5
1 Na ional Heal h Insu ance Fund, 1 K ichim s ., So ia 1407, Bulga ia
2 Labo a o y o Social Pha macy, Facul y o Chemis y and Pha macy, So ia Uni e si y “Sain Klimen Oh idski”, 1 James Bou chie bl d., So ia 1164,
Bulga ia
3 Depa men o Su ge y, Alexand o ska Uni e si y Hospi al, Medical Uni e si y o So ia, 1, S . G. So iyski s ., So ia 1431, Bulga ia
4 Depa men o O ganiza ion and Economics o Pha macy, Facul y o Pha macy, Medical Uni e si y o So ia, 2 Duna s ., So ia 1000, Bulga ia
5 Depa men o Rheuma ology, Medical Uni e si y o So ia, 1 Dimi a Mollo s ., So ia 1704, Bulga ia
Co esponding au ho :
Valen ina Pe ko a ( pe ko[email p o ec ed])
Recei ed
18 Oc obe 2025♦
Accep ed
3 No embe 2025♦
Published
24 No embe 2025
Ci a ion:
Asipo a N, Ognyano S, Yo dano E, Angelo K, H is o E, Komi o a M, Pe ko a V, S oyano a S, Pa o a I (2025) Impac
o COVID-19 on heal h- ela ed quali y o li e in s uden s and PhD s uden s: a sys ema ic e iew. Pha macia 72: 1–12. h ps://doi.
o g/10.3897/pha macia.72.e175314
Abs ac
His o ically, epidemics ha e always posed a global h ea o humani y no only in e ms o heal h and i s domains – physical, social,
and psychological – bu also in all sphe es o human exis ence, including he economic, social, poli ical, e hnocul u al, and eligious.
Rega dless o hei cause o ou e o sp ead, he measu es aken o limi he epidemics ha ha e occu ed ha e always aimed o
es ic human ac i i ies in di e en ways and o a ying deg ees. The aim o his s udy is o de e mine he impac o an i-epidemic
measu es agains he COVID-19 pandemic on heal h- ela ed quali y o li e in a a ge g oup – s uden s and PhD s uden s. Ma e ials
and me hods: We conduc ed a sys ema ic e iew o scien i ic publica ions in jou nals e e enced and indexed in wo ld- enowned
da abases using keywo ds – a o al o 90. We applied he c i e ia sys em o he PICOS ool o assess ou comes. Resul s and discussion:
We ound a high equency o anxie y, dep essi e symp oms, s ess, insomnia, and educed quali y o li e in he obse ed popula ion
o 13,704 s uden s and PhD s uden s. The nega i e impac o he pandemic on he men al heal h and quali y o li e o s uden s and
PhD s uden s is complex and mul i ac o ial. The impo ance o he uni e si y en i onmen , no only as an academic space bu also
as a social and heal h space, can play a key ole in building esilience among young people in u u e c isis si ua ions.
Keywo ds
COVID-19, dep ession, doc o al s uden s, heal h- ela ed quali y o li e, heal h s a us, men al heal h, quali y o li e, SARS-CoV-2,
s uden s
Copy igh Asipo a N e al. This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion License
(CC-BY 4.0), which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal au ho and sou ce
a e c edi ed.
Pha macia 72: 1–12
DOI 10.3897/pha macia.72.e175314
Resea ch A icle
Asipo a N e al.: Impac o COVID-19 on heal h- ela ed quali y o li e2
In oduc ion
His o ically, epidemics and pandemics ha e always ep e-
sen ed a global h ea o humani y in gene al and in pa ic-
ula , no only in e ms o heal h and i s domains – physical,
social, and psychological – bu also in all sphe es o hu-
man exis ence – economic, social, poli ical, e hnocul u al,
and eligious. Despi e signi ican p og ess in medicine and
public heal h since he 19 h cen u y, humani y con inues
o ace de as a ing epidemics and pandemics (Boni a e
al. 2006; Hu emo ić 2019; Sampa h e al. 2021). The i s
chole a pandemic began in India in 1817. A o al o six
pandemics caused by Vib io chole ae h ough con amina -
ed wa e sp ead by 1923, and he se en h, which began in
1961 in Indonesia, is belie ed o s ill be ongoing (Hu e-
mo ić 2019). The Spanish lu pandemic o 1918, caused by
he H1N1 s ain, was he i s ue global pandemic o a -
age he wo ld and he i s o occu wi hin he amewo k
o mode n medicine. I claimed he li es o o e 50 million
people, o e e changing mode n medicine and epidemi-
ology (Boni a e al. 2006). The scien i ic li e a u e also p o-
ides su icien and well-sys ema ized da a on o he ypes
o pandemics. HIV/AIDS is a slowly p og essi e global
pandemic ha began in he ea ly 1980s and was ini ially
ma ked by high mo ali y and s ong social s igma. HIV
a ec s abou 40 million people wo ldwide and has killed
almos he same numbe o people since 1981. Smallpox,
a highly con agious disease wi h a high mo ali y a e, was
he i s disease o which a accine was de eloped in 1798
and, hanks o a coo dina ed global e o , was e adica ed
by he end o he 20 h cen u y – one o he g ea es suc-
cesses in he his o y o public heal h. The 2009 H1N1 pan-
demic, known as “swine lu,” was one o he i s pandemics
o include men al heal h aspec s in policy epo s on p e-
pa edness and mi iga ion (Hu emo ić 2019; Sampa h e al.
2021). The Ebola i us eme ged in Cen al and Wes A i-
ca, i s iden i ied in 1976, and, in 2013, caused signi ican
ou b eaks wi h o e 28,000 cases and o e 11,000 dea hs
(Sampa h e al. 2021). Zika i us in ec ion, eco ded in
Mic onesia in 2007 and in B azil in 2015, can cause Guil-
lain-Ba é synd ome in adul s and se e e mic ocephaly in
unbo n child en o in ec ed mo he s (Hu emo ić 2019;
Sampa h e al. 2021). The i s co ona i us se e e acu e
espi a o y synd ome (SARS-CoV) o igina ed in ba s and
was ansmi ed o humans ia ca s, causing se e e acu e
espi a o y synd ome (SARS) in humans in 2003; howe e ,
no human cases ha e been epo ed since 2004. The s udy
o SARS p o ides aluable in o ma ion abou he men al
heal h o a ec ed indi iduals, amilies, and en i e commu-
ni ies, including he men al heal h issues aced by heal h
p o essionals (WHO 2022). The i s ansmission o he
Middle Eas espi a o y synd ome co ona i us (MERS-
CoV) was obse ed in 2012, ansmi ed om camels o
humans, causing MERS, wi h in ec ions la gely con ined
o he A abian Peninsula (Boni a e al. 2006; Hu emo -
ić 2019; Sampa h e al. 2021; WHO 2022). COVID-19,
caused by SARS-CoV-2, eme ged in la e 2019 and sp ead
apidly a ound he wo ld. Because SARS-CoV-2 is a no el
i us and mos people ha e no immuni y o i , he en i e
human popula ion was conside ed po en ially suscep ible
o in ec ion. In he i s 2 yea s o he COVID-19 pandem-
ic, mo e han 450 million cases we e epo ed wo ldwide
– mo e han 100 million in he Eu opean Union (EU) and
Eu opean Economic A ea (EEA). Because some in ec ed
indi iduals may be asymp oma ic and no all symp oma ic
indi iduals a e es ed, i is es ima ed ha he numbe o un-
diagnosed cases is much highe (WHO 2022).
Rega dless o hei cause and ou e o sp ead, he mea-
su es aken o limi he epidemics ha ha e occu ed ha e
his o ically always aimed o es ic human ac i i ies in
di e en ways and o a ying deg ees. An i-epidemic
measu es o ai bo ne in ec ions a e based on he basic
p inciples o epidemiology and a e managed globally by
he Wo ld Heal h O ganiza ion (WHO), na ional heal h
au ho i ies, and compe en ins i u ions. The measu es aim
o limi he sp ead o pa hogens ansmi ed by ai bo ne
d ople s and include isola ion o he sick, qua an ine, so-
cial dis ancing, wea ing p o ec i e masks, hand hygiene,
en ila ion in indoo a eas, disin ec ion o su aces, acci-
na ion, and ea ly diagnosis (WHO 2020). In he 20 h cen u-
y, an i-epidemic measu es e ol ed signi ican ly hanks o
ad ances in science and medicine. A he beginning o he
cen u y, be o e he disco e y o an ibio ics and accines o
many diseases, measu es mainly ocused on hygiene, isola-
ion, and limi ing he sp ead. Towa d he end o he cen u-
y, wi h he ad en o accines and a be e unde s anding
o pa hogens, he ocus shi ed o mass immuniza ion, de-
elopmen o an i i al d ugs, p e en ion and popula ion
educa ion, in e na ional coo dina ion, and s anda ds o
disease con ol. Du ing COVID-19, he WHO, he EU,
and he Uni ed S a es ecommended adhe ence o he
basic p inciples o epidemiology, such as dis ancing, iso-
la ion, qua an ine, and es ic ion o social and economic
ac i i ies. China implemen ed a o al closu e o i s bo de s
and comple e isola ion. The Bulga ian heal h au ho i ies
e e ed o he ecommenda ions o bo h he WHO and
he EU, and on Ma ch 13, 2020, a s a e o eme gency was
decla ed as a measu e o limi he sp ead o he co ona i-
us. As a esul o he decla ed epidemic si ua ion, se e al
measu es we e imposed, such as wea ing pe sonal p o ec-
i e equipmen , main aining social dis ance, sel -isola ion,
qua an ining con ac and in ec ed ci izens, and suspend-
ing isi s o comme cial es ablishmen s and o he enues
whe e people ga he ed. Classes and all ex acu icula
ac i i ies we e suspended, and educa ional and almos all
wo k p ocesses mo ed o an elec onic en i onmen . The
leading an i-epidemic measu es can be sys ema ized in
se e al di ec ions – isola ion, qua an ine, and ea men .
Aim o he s udy
To s udy he impac o an i-epidemic measu es agains he
COVID-19 pandemic on he quali y o li e, and in pa -
icula , he heal h- ela ed quali y o li e in a a ge g oup
– s uden s and doc o al s uden s. To iden i y he conse-
Pha macia 72: 1–12 3
quences o he pandemic a ec ing he social li e, eelings,
sa is ac ion, and pe cep ions o he a ec ed indi iduals.
We chose he a ge g oup in his way because, o many
young people, being a s uden is a d eam come ue and a
sou ce o p ide. On he o he hand, i is he desi e o pa -
en s o hei child en o be highly educa ed and o be p o-
ided wi h he oppo uni y, ega dless o hei inancial
si ua ion, o ecei e an educa ion o he highes deg ee.
The pe iod o s udy co e s a special s age o human de el-
opmen – he age be ween 18 and 19 and 23 and 25 yea s.
This is a ime when young people ully ma u e in physi-
cal, psychological, and social aspec s, acqui e he igh s o
adul ci izens, and a e ambi ious o ealize hemsel es a
all cos s (Ge go e al. 2021). The COVID-19 pandemic
u ned he li es o young people in his age g oup upside
down, ega dless o hei social s a us, ma e ial and inan-
cial secu i y, o cul u al, e hnic, and eligious di e ences.
Ma e ials and me hods
We conduc ed a sys ema ic e iew o scien i ic publica-
ions in acco dance wi h he ecommenda ions o he Co-
ch ane Collabo a ion and he P e e ed Repo ing I ems
o Sys ema ic Re iews and Me a-Analyses (PRISMA)
guidelines (Mohe e al. 2009; Hu on e al. 2015; Sham-
see e al. 2016). Topic o he sys ema ic e iew: Impac o
COVID-19 on heal h- ela ed quali y o li e in s uden s and
PhD s uden s. Design: Re ospec i e obse a ional s udy.
Sea ch s a egy: We conduc ed a sea ch o publica ions
and epo s published in scien i ic jou nals e e enced and
indexed in wo ld- enowned scien i ic in o ma ion da a-
bases by keywo ds. Sea ch language – No language es ic-
ions we e applied. Da abases – PubMed, Scopus, Web
o Science, and Google Schola . Keywo ds: COVID-19,
dep ession, heal h- ela ed quali y o li e, heal h s a us,
heal hy olun ee s, pha macy s uden s, PhD s uden s,
quali y o li e, s uden s. S udy pe iod: Janua y 2020–De-
cembe 2023. Fo he analyzed pe iod o 4 yea s, we ound
90 scien i ic publica ions. E alua ed esul s and inclusion
c i e ia: We analyzed scien i ic publica ions ha included
a leas one o he keywo ds. Inclusion c i e ia o scien i ic
publica ions: The scien i ic a icle should examine he im-
pac o COVID-19 on heal h- ela ed quali y o li e; s udy
pa icipan s should be s uden s o PhD s uden s. Da a ex-
ac ion: Two o he au ho s ex ac ed da a om he e-
sea ch a icles ha we e de e mined o mee he inclusion
c i e ia independen ly o each o he . Fo he p esen s udy,
he ollowing da a we e ex ac ed: i s au ho ’s su name,
yea o publica ion, coun y o o igin, ype o scien i -
ic communica ion, ype o s udies, designs, coun ies in
which he s udies we e conduc ed, COVID-19, HRQoL,
QoL, s uden s, PhD s uden s, e c. S a is ical analyses: We
used he open-sou ce s a is ical so wa e Jamo i and Mic-
oso Excel 2024. We pe o med desc ip i e analysis and
analysis o a iance on he da a. Resul s a e p esen ed as
absolu e and ela i e equencies using uni a ia e and bi-
a ia e equency dis ibu ion ables.
We used he c i e ia sys em o he PICOS ool –
Popula ion, In e en ion, Compa ison, Ou comes, and
S udy design (Me hley e al. 2014) – o assess ou comes.
The PICO ool ocuses on he popula ion s udied, he
ype o in e en ion, compa ison, and assessmen o
ou comes, mos commonly quan i ied, and is common-
ly used o iden i y componen s o clinical e idence o
sys ema ic e iews in e idence-based medicine and has
been adop ed by he Coch ane Collabo a ion (Higgins
and G een 2013). In he modi ied e sion o PICOS, “S”
e e s o s udy design; hus, we limi ed he numbe o
i ele an esea ch a icles and also ocused on ce ain
quali a i e indica o s.
Resul s and discussion
The li e a u e sea ch was limi ed o a icles published in
English and Bulga ian. In he ini ial sea ch, we ound 90
scien i ic publica ions, e iewed all 90 i les and abs ac s,
and hen analyzed he ull ex s o he a icles. We exclud-
ed 70 a icles because hey did no con ain he keywo d
“COVID-19” in hei desc ip ion. In he inal s age, we
excluded 3 a icles because hey did no con ain in o -
ma ion on he assessmen o heal h- ela ed quali y o li e
in s uden s o PhD s uden s. As a esul o he sys ema ic
e iew, we selec ed 17 scien i ic publica ions o e e o.
The selec ion o scien i ic publica ions is p esen ed in he
ollowing igu e as a PRISMA low diag am (Fig. 1).
Table 1 p esen s he main cha ac e is ics o 17 s udies
assessing he impac o he COVID-19 pandemic on men-
al heal h, quali y o li e, and ela ed beha io al ac o s
among s uden popula ions om di e en coun ies. The
o al sample size included o e 13,000 pa icipan s om
Eu ope, No h Ame ica, Sou h Ame ica, he Middle Eas ,
and Asia, wi h mos s udies conduc ed using online su -
ey me hods and alida ed scales o assess men al heal h
and quali y o li e (PHQ-9, GAD-7, SF-12, SF-36, WHO-
QOL-BREF, MSPSS, PSQI, e c.).
O e 70% o he esea ch was published in 2022, likely
e lec ing a peak in scien i ic in e es a e he i s da a
om he pandemic had accumula ed and uni e si ies had
adap ed o he new eali y. A smalle numbe o publica-
ions appea ed a he beginning o he pandemic (2020–
2021) and a a la e s age (2023), when he opic was al-
eady pa ially exhaus ed (Table 2).
Six een s udies wi h a ailable da a sui able o sampling
we e included in he analysis ( o one o he s udies, no
da a on he numbe o pa icipan s we e a ailable). The
a e age numbe o pa icipan s was 857 s uden s (95% CI:
526–1187). The median was 630, indica ing ha hal o
he s udies had ewe han 630 pa icipan s and he o he
hal had mo e. The sample sizes a ied conside ably, om
56 o 2031 pa icipan s. The s anda d de ia ion was 619,
highligh ing he la ge a iabili y be ween s udies. The
Shapi o–Wilk es (p = 0.120) did no indica e a signi i-
can de ia ion om no mali y; he e o e, he dis ibu ion
o sample sizes was app oxima ely no mal (Table 3).
Asipo a N e al.: Impac o COVID-19 on heal h- ela ed quali y o li e4
Reco ds iden ified h ough
da abase sea ch
(n = 90)
Reco ds sc eened
(n = 90)
Full- ex a icles assessed o
eligibili y
(n = 20)
S udies included in he
quali a i e analysis
(n = 17)
Reco ds excluded – COVID-19 no
p esen
(n = 70)
Full- ex a icles excluded –
s uden s o PhD s uden s no
p esen
(n = 3)
S udies included in he
quan i a i e analysis
(n = 17)
Iden ifica ion
Sc eening
Eligibili y
Included
Figu e 1. O e iew o he sea ch p ocess – PRISMA low diag am.
The da a in Table 4 indica e ha 2022 is he pe iod in
which scien i ic in e es eached i s peak, bu his g ow h
was no e enly dis ibu ed ac oss coun ies. In he ea ly
phases o he 2020–2021 pandemic, publica ions we e
a he isola ed and na ionally limi ed, e.g., G eece, USA,
I aly, and Spain. This e lec s apid, o en single-cen e
s udies aimed a documen ing he ini ial e ec s o he
pandemic. In 2022, wide geog aphical pa icipa ion was
al eady isible – coun ies om di e en egions such as
Eu ope, Asia, La in Ame ica, and he Middle Eas we e
included. This demons a es a consolida ion o scien i ic
in e es and mo e s uc u ed esea ch ini ia i es. The ac
ha in 2023 only one s udy was published – he USA – can
be in e p e ed as a pa ial exhaus ion o he opic o a e-
di ec ion o he esea ch ocus o pos -pandemic aspec s.
In 2020, he men al heal h, se e i y o dep ession, and
anxie y o college s uden s du ing he COVID-19 pandem-
ic we e in es iga ed in he Uni ed S a es using he Pa ien
Heal h Ques ionnai e-9 (PHQ-9) and Gene al Anxie y
Diso de -7 (GAD-7) ques ionnai es (Wang e al. 2020).
Responden s had conce ns ela ed o hei academic and
heal h s a us and hei li es yle. O he 2,031 pa icipan s,
48.14% showed mode a e o se e e dep ession, 38.48%
had mode a e o se e e anxie y, and 18.04% had suicidal
hough s, wi h mos pa icipan s indica ing ha hei s ess
and anxie y le els had inc eased du ing he pandemic.
Pha macia 72: 1–12 5
Table 1. PICOS syn hesis o s udies on he impac o COVID-19 on g oups o s uden s and PhD s uden s.
Popula ion In e en ion Compa ison Ou comes S udy design
2031 Online su eys (Pa ien
Heal h Ques ionnai e-9 and
Gene al Anxie y Diso de -7)
o dep ession and anxie y,
and addi ional mul iple-
choice and open-ended
ques ions ega ding s esso s
and coping mechanisms
speci ic o COVID-19.
Di e ences by gende
and classi ica ion o
unde g adua e and
g adua e s uden s.
Associa ion be ween
pandemic and inc eased
le els o dep ession,
anxie y, and suicidal
hough s.
48.14% showed a mode a e- o-se e e le el o
dep ession, 38.48% showed a mode a e- o-se e e
le el o anxie y, and 18.04% had suicidal hough s.
A majo i y o pa icipan s (71.26%) indica ed ha
hei s ess/anxie y le els had inc eased du ing he
pandemic. Less han hal o he pa icipan s (43.25%)
indica ed ha hey we e able o cope adequa ely wi h
he s ess ela ed o he si ua ion.
C oss-sec ional
s udy (online
su ey)
1296 Pe cei ed social suppo
was measu ed using he
Mul idimensional Scale o
Pe cei ed Social Suppo
(MSPSS).
S uden s wi h be e
s. wo se quali y o li e
du ing COVID-19.
Family social suppo p edic ed COVID-19 QoL;
he e we e signi ican gende di e ences in social
suppo and QoL; and highe pe cei ed suppo was
linked wi h be e QoL.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
1765 Online 128-i em
ques ionnai e assessing
men al heal h, QoL, and
coping s a egies.
Associa ions be ween
sociodemog aphic/
lockdown ac o s and
men al heal h/QoL
ou comes (e.g., gende ,
isola ion, inancial s ess).
High p e alence o anxie y (58.1%), dep ession
(11.6%), auma ic symp oms (19.5% IES-R>33),
and suicidal idea ion (4.4%); poo e men al HRQoL
compa ed o physical; emale gende , isola ion,
and inancial and exam s ess linked wi h poo e
ou comes.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
381 Online su eys (Google
Fo ms) assessing pe cep ion
o landscape and impo ance
o ec ea ional a eas du ing
COVID-19.
S uden s‘ pe cep ions
be o e s. du ing he
pandemic.
Inc eased impo ance o ec ea ional a eas; s onge
app ecia ion o na u e, scenic iews, and he apeu ic
e ec s o landscape; ecommenda ion o mo e
di e se and accessible g een a eas.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
556 Measu emen o sma phone
addic ion (I alian scale,
alida ed), academic
p oc as ina ion, and quali y
o li e.
Di e ences by gende
and educa ional s age;
analysis o ela ionships
be ween p oc as ina ion,
QoL, and sma phone
addic ion.
37.4% addic ed o sma phones; 7.7% high
p oc as ina ion; 62.8% mode a e p oc as ina ion.
Sma phone addic ion was posi i ely co ela ed wi h
p oc as ina ion and nega i ely wi h QoL. No signi ican
gende /s age di e ences in addic ion o QoL, bu
p oc as ina ion is highe in males and unde g adua es.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
500 Online WHOQOL-BREF
ques ionnai e assessing
quali y o li e.
Di e ences in quali y o
li e by ield o s udy and
medical knowledge.
Women in echnical s udies had he lowes esilience;
women in medical sciences showed highe esilience;
o e all di e ences we e obse ed in QoL domains
depending on he s udy ield.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
471 Online su ey measu ing
e-lea ning sa is ac ion, QoL,
sociali y, s ess, and coping
s a egies.
Associa ions be ween
sa is ac ion and
demog aphic/
psychological ac o s
(age, s ess, coping,
social p esence).
Mean sa is ac ion sco e 30.6; s ess sco e 19.4;
s uden s epo ed psychological and physical
su e ing 14 days/mon h. E-lea ning sa is ac ion is
posi i ely linked wi h age, cou se a endance, social
p esence, and coping (sel -blame, eligion) and
nega i ely wi h s ess/unheal hy days.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
1842 Online su ey measu ing
men al heal h- ela ed QoL
(SF-36), dep ession, anxie y,
and li es yle ac o s (e.g.,
smoking, alcohol, physical
ac i i y).
Gende -speci ic analyses
o associa ions be ween
li es yle ac o s and
men al heal h indica o s.
S uden s had lowe men al HRQoL han Ge man/
Ame ican no ms; women epo ed wo se men al
heal h han men. Nega i e associa ions: emale
gende , younge age, unde weigh , smoking,
d ug use. Posi i e associa ions: mode a e alcohol
consump ion ( emales), physical ac i i y (males).
Obse a ional,
c oss-sec ional
s udy (online
su ey)
887 Measu emen o physical
ac i i y, si ing ime, empa hy
(cogni i e and a ec i e),
and pe cei ed social suppo
be o e and a e easing
campus es ic ions.
Du ing campus access
es ic ions s. a e
easing es ic ions.
Physical ac i i y (mode a e, igo ous, and o al)
inc eased a e easing es ic ions; walking was
unchanged. Female s uden s epo ed highe
cogni i e empa hy a e easing es ic ions. Inc eases
in physical ac i i y co ela e posi i ely wi h a ec i e
empa hy and amily suppo .
Obse a ional,
c oss-sec ional
s udy (online
su ey)
433 S anda dized sel - epo
scales measu ing anxie y,
dep ession, s ess,
psychological well-being,
academic sa is ac ion, and
COVID-19– ela ed s ess on
lea ning expe ience.
Associa ions be ween
academic sa is ac ion
s. COVID-19 s ess
on lea ning and men al
heal h indica o s.
Academic sa is ac ion was a s onge p edic o
o men al heal h han COVID-19 s ess. Low
sa is ac ion was linked o highe s ess, dep ession,
and anxie y; high sa is ac ion was linked o be e
psychological well-being. The emale gende is
associa ed wi h mo e anxie y and s ess.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
353 Online su ey assessing
e-lea ning expe ience,
sc een exposu e ime, and
sel - epo ed headaches.
Associa ions be ween
sc een exposu e
du a ion and headache
p e alence/se e i y.
65.72% p e alence o headaches; 52.69% high sc een
exposu e ime. Inc eased sc een ime is signi ican ly
linked o highe headache and mig aine epo ing.
S uden s we e mode a ely sa is ied wi h online
lea ning bu epo ed communica ion challenges;
hey p e e ed blended lea ning.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
Asipo a N e al.: Impac o COVID-19 on heal h- ela ed quali y o li e6
Popula ion In e en ion Compa ison Ou comes S udy design
1279 Online ques ionnai e
including he Pi sbu gh
Sleep Quali y Index,
Insomnia Se e i y Index,
SF-12 Heal h Su ey, and
Pe cei ed S ess Scale.
S uden s wi h poo sleep
quali y/insomnia s.
hose wi h good sleep
quali y.
65% had poo sleep quali y; 55% had insomnia
symp oms. Poo sleep and insomnia a e associa ed
wi h highe s ess and lowe physical and men al
HRQoL. Reg ession analysis con i med sleep quali y
signi ican ly p edic ed HRQoL.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
703 Online su ey measu ing
sociodemog aphics, physical
ac i i y, bu nou synd ome,
quali y o li e (QoL), and
pe cep ions o online
lea ning.
Clus e analysis
iden i ying di e en
s uden p o iles (low
QoL, in e media e QoL,
be e QoL).
Low QoL g oup: younge , mainly emale, highe
p e alence o psychological diso de s, highe
bu nou , wo se QoL, poo e online lea ning
pe cep ion. In e media e QoL g oup: olde , mo e
men, ma ied/wi h child en, be e online lea ning
pe cep ion. Be e QoL g oup: highe QoL, lowe
bu nou , mo e physical ac i i y, be e online lea ning
pe cep ion.
C oss-sec ional
clus e analysis
151 Online su ey wi h mul iple
s anda dized es s: SF-36
Heal h Su ey, S a e-T ai
Anxie y In en o y, Beck
Dep ession In en o y,
Pe cei ed S ess Scale,
Loneliness Scale, Sleep
Quali y Ra ing, and
Accep ance and Ac ion
Ques ionnai e.
Male s. emale s uden s
on psychological s ess,
heal h- ela ed quali y o
li e, and men al heal h
indica o s.
Female s uden s epo ed wo se gene al heal h
pe cep ion, QoL, highe dep ession, anxie y,
s ess, loneliness, poo e sleep quali y, and mo e
psychological in lexibili y compa ed o males.
Obse a ional,
c oss-sec ional
s udy (online
su ey)
56 Measu emen s o
physical ac i i y, si ing
ime, adhe ence o he
Medi e anean die , and
body composi ion.
Associa ions be ween
li es yle ac o s (ac i i y,
die , seden a y ime) and
HRQoL.
19.64% spen >10 hou s/day si ing; mean si ing ime
was 8.26 hou s. 92.86% me WHO 2020 physical ac i i y
ecommenda ions. 51.8% showed low adhe ence o
he Medi e anean die . 39.2% and 46.4% sco ed in
he lowes quin ile o physical and men al HRQoL,
espec i ely. Nega i e co ela ion be ween physical
unc ion and si ing ime ( = –0.38).
Obse a ional,
c oss-sec ional
s udy
N/A * Rapid sys ema ic e iew
o psychological impac o
COVID-19 on s uden s.
Obse a ional s udy
assessing a ini y o
e-lea ning and i s e ec on
s uden s’ well-being.
Men al heal h ou comes
in ela ion o s uden s’
a ini y o e-lea ning
adop ion.
Pandemic and lockdown we e associa ed wi h s ess,
anxie y, dep ession, dis ess, and educed well-being.
A ini y o e-lea ning ac ed as a bu e , posi i ely
in luencing s uden s’ esilience and men al heal h
du ing COVID-19.
Obse a ional,
sys ema ic e iew
1000 Online su ey assessing
men al heal h (anxie y,
dep ession, suicidal idea ion,
sleep, QoL, a i udes owa d
conspi acy heo ies).
Men al heal h s a us
be o e s. du ing he
COVID-19 lockdown
(sel - epo ed changes).
Anxie y inc eased by 42.5%, dep ession by 74.3%,
and suicidal hough s by 63.3%. Sleep quan i y
inc eased o 66.3%, bu quali y wo sened o 43%.
QoL wo sened o 57%. Clinical cases o dep ession
inc eased 2.5–3- old; suicidal hough s inc eased ~8-
old. Abou 30% accep ed, and abou 20% we e open
o conspi acy heo ies.
Obse a ional,
c oss-sec ional
s udy
* does no con ain in o ma ion on he numbe o pa icipan s.
Again in he USA, an obse a ional s udy was con-
duc ed on pe cei ed social suppo and he impac o
COVID-19 on he quali y o li e o 1,296 s uden s om
a la ge public uni e si y in he Midwes (Cahuas e al.
2023). The s udy was conduc ed using wo ques ionnai es:
he Mul idimensional Scale o Pe cei ed Social Suppo
and he COVID-19 Impac on Quali y o Li e scale. The
esul s showed ha pe cei ed social suppo om amily
was an impo an p edic o o quali y o li e o he en i e
g oup. Signi ican di e ences we e ound be ween men
and women in e ms o pe cei ed social suppo , as well as
quali y o li e du ing COVID-19. The g oup wi h a be e
quali y o li e had highe sco es on pe cei ed social sup-
po han he g oup wi h a low quali y o li e. The conclu-
sion was ha social suppo om amily may ac as a key
bu e o quali y o li e du ing he COVID-19 pandemic
among college s uden s. Due o he limi a ion o social in-
e ac ions du ing he COVID-19 pandemic, main aining
access o social suppo was ex emely impo an .
In 2020, an online su ey was conduc ed in F ance:
“Sel - epo ed men al heal h symp oms, quali y o li e and
coping s a egies in F ench heal h science s uden s du ing
he ea ly s age o he COVID-19 pandemic” (Leaune e al.
2020). An online ques ionnai e con aining 128 i ems was
Table 2. Dis ibu ion o included s udies by yea o publica ion.
Yea Coun s % o o al Cumula i e %
2020 2 11.8% 11.8%
2021 2 11.8% 23.5%
2022 12 70.6% 94.1%
2023 1 5.9% 100.0%
Pha macia 72: 1–12 7
sen o 17,673 heal h science s uden s a he Claude Be -
na d Uni e si y Lyon in Ap il 2020. I assessed sociodemo-
g aphic cha ac e is ics, lockdown condi ions, dep essi e,
anxie y, and auma symp oms, heal h- ela ed quali y o
li e, and coping s a egies. The ques ionnai es we e com-
ple ed by 1,765 s uden s. Thei men al heal h- ela ed qual-
i y o li e sco es we e signi ican ly wo se han hei physical
heal h. Fac o s associa ed wi h wo se men al heal h we e
emale gende , COVID-19-like symp oms, social isola ion,
pandemic- ela ed inancial cons ain s, and exam s ess.
F ench heal h science s uden s showed high le els o men-
al heal h p oblems and poo men al heal h- ela ed quali y
o li e du ing he ea ly s age o he COVID-19 pandemic.
Be na e al. in es iga ed he impac o landscape and
he impo ance o ec ea ional a eas o uni e si y s uden s
in Lublin du ing he pandemic. The aim o he s udy was
o de e mine whe he and o wha ex en he COVID-19
pandemic a ec ed he impo ance o ec ea ional a eas
and he pe cep ion o landscape among s uden s – a social
g oup ha is inc easingly expe iencing mood diso de s
and is s ongly a ec ed by he lockdown. The s udy was
conduc ed in wo s ages among 381 s uden s (Be na e
al. 2022). I was ound ha he impo ance o ec ea ion-
al a eas inc eased du ing he pandemic. The pe cep ion
o landscape also changed, wi h na u e, scenic iews, and
he he apeu ic e ec o landscapes being app ecia ed o
a g ea e ex en . The esul s o he s udy show he need o
p o ide a a ie y o g een spaces, imp o e hei accessi-
bili y, c ea e quie a eas, p o ide g een mobili y, and o e
places o ec ea ion.
Ano he s udy iden i ied he le el and p opo ions o
sma phone addic ion and academic p oc as ina ion and
measu ed quali y o li e by gende and s age o s udy among
s uden s in ligh o he COVID-19 pandemic (Albu san e
al. 2020). The s udy included 556 Saudi uni e si y s uden s
aged 18 o 52 yea s. Measu es o academic p oc as ina ion
and quali y o li e we e used in addi ion o he I alian Scale
o Sma phone Addic ion. A o al o 37.4% o he sample
we e addic ed o sma phone use, while 7.7% had a high
le el o p oc as ina ion in hei uni e si y du ies and 62.8%
had an a e age le el o p oc as ina ion. A s a is ically sig-
ni ican posi i e ela ionship was ound be ween academic
p oc as ina ion and sma phone addic ion, a s a is ically
signi ican nega i e ela ionship be ween sma phone ad-
dic ion and quali y o li e, and a nega i e ela ionship be-
ween quali y o li e and academic p oc as ina ion.
Assessmen o he quali y o li e o Polish uni e si y
s uden s du ing he COVID-19 pandemic acco ding o
he WHO quali y o li e ques ionnai e was ca ied ou by
T zcionka and collabo a o s. The s udy popula ion con-
sis ed o 500 s uden s om h ee Polish uni e si ies – he
Medical Uni e si y o Silesia, he Ma i ime Uni e si y
in Szczecin, and Adam Mickiewicz Uni e si y, Poznań
(T zcionka e al. 2022). The s udy pa icipan s comple ed
an online quali y o li e ques ionnai e (WHOQOL-BREF)
c ea ed by he WHO. The ob ained esul s showed di e -
ences in esponden s’ eac ions in wo domains. The low-
es esilience o c i ical si ua ions was obse ed in women
who s udied a he echnical uni e si y. Highe esilience
alues we e obse ed in women s udying medical sciences.
In 2021, he s udy “E-Lea ning Sa is ac ion, S ess,
Quali y o Li e, and Coping: A C oss-Sec ional S udy in
I alian Uni e si y S uden s a Yea a e he COVID-19
Pandemic Began” (Co ini e al. 2021) was conduc ed. The
s udy was ca ied ou online and included 471 s uden s
a ending he Uni e si y o L‘Aquila in Ab uzzo om
June o July 2021. The p ima y objec i e was o assess
sa is ac ion wi h e-lea ning, measu ed by he E-lea ning
Sa is ac ion Scale, and seconda y ou comes s udied i s e-
la ionship wi h demog aphic ac o s, pe cei ed quali y o
li e, sociabili y, s ess, and coping s a egies using a hie a -
chical eg ession model. The esul s showed ha s uden s
su e ed om men al and physical discom o o 14 days
pe mon h. Sa is ac ion wi h e-lea ning was signi ican ly
associa ed wi h age and cou se a endance. I was posi i e-
ly associa ed wi h social p esence sco e and coping s a e-
gies and was in e sely ela ed o s ess and unheal hy days.
In conclusion, he au ho s belie e ha esponden s we e
inclined o use e-lea ning despi e he end o qua an ine.
Sociabili y, s ess, quali y o li e, and coping s a egies play
an impo an ole in s uden s‘ sa is ac ion wi h e-lea ning.
Spage e al. conduc ed a gende -speci ic mul i a i-
able analysis o men al heal h indica o s and hei asso-
cia ion wi h li es yle in Ge man s uden s. The analyses
we e based on a da a se collec ed h ough an online su -
ey among 1,842 s uden s a a Ge man uni e si y o ap-
plied sciences in 2014 (Spage e al. 2022). The indica o s
used we e men al heal h- ela ed quali y o li e (men al
HRQoL), dep ession, and anxie y, which we e analyzed in
a gende -speci ic manne . The mean men al heal h- ela ed
Table 3. Dis ibu ion o he numbe o pa icipan s in he an-
alyzed s udies.
Numbe o s udies 16 * Popula ion (P)
Missing 1
Mean 857
S anda d e o mean 155
95% CI mean lowe bound 526
95% CI mean uppe bound 1187
Median 630
Mode 56.0 **
Sum 13704
S anda d de ia ion 619
Minimum 56.0
Maximum 2031
Skewness 0.699
S anda d e o skewness 0.564
Ku osis -0.698
S anda d e o ku osis 1.09
Shapi o-Wilk W 0.911
Shapi o-Wilk p 0.120
* One o he s udies did no con ain in o ma ion on he numbe o pa -
icipan s.
No e. The CI o he mean assumes sample means ollow a -dis ibu ion
wi h N – 1 deg ees o eedom.
** Mo e han one mode exis s; only he i s is epo ed.
Asipo a N e al.: Impac o COVID-19 on heal h- ela ed quali y o li e8
quali y o li e o he s uden s s udied (46.68), as measu ed
by he SF-36 ques ionnai e, was lowe han he popula ion
no m in Ge many (48.76) and Ame ica (51.34). A key
inding was he di e ences in men al heal h indica o s be-
ween male and emale s uden s. Women epo ed a wo se
men al heal h s a us han men. Con a y o popula belie ,
s uden s had wo se men al heal h han he gene al pop-
ula ion e en be o e he pandemic. Due o he addi ional
men al s ess caused by he pandemic, i can be assumed
ha men al heal h p oblems ha e inc eased e en mo e.
The au ho s concluded ha uni e si ies should pay mo e
a en ion o he men al heal h o hei s uden s.
S uden s in Japan we e comple ely es ic ed om ac-
cessing campuses du ing he COVID-19 pandemic, wi h
only online lea ning aking place. Shima e al. e alua ed
he impac o campus closu es on physical ac i i y, em-
pa hy, and social suppo among s uden s du ing he
COVID-19 pandemic. The s udy measu ed 887 s uden s’
physical ac i i y le els, si ing ime, cogni i e and a ec i e
empa hy, and pe cei ed social suppo be o e and a e he
easing o campus access es ic ions (Shima e al. 2022).
The esul s showed ha o e all ac i i y le els inc eased
a e he easing o campus access es ic ions. Cogni i e
empa hy sco es signi ican ly inc eased among emale s u-
den s a e he easing o es ic ions, while no inc ease was
obse ed among male s uden s. Fu he mo e, changes in
physical ac i i y we e posi i ely associa ed wi h changes
in a ec i e empa hy sco es and pe cei ed amily suppo .
In addi ion, changes in a ec i e empa hy sco es we e
posi i ely associa ed wi h pe cei ed social suppo om
amily, iends, and lo ed ones. The indings sugges ha
inc easing le els o physical ac i i y ollowing he easing
o campus access es ic ions could lead o be e quali y
o li e o young people du ing he COVID-19 pandemic.
Table 4. Dis ibu ion o included s udies by coun y and yea o publica ion.
Coun y Yea To al
2020 2021 2022 2023
B azil Obse ed 0 0 1 0 1
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 8.3% 0.0% 5.9%
F ance Obse ed 0 0 1 0 1
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 8.3% 0.0% 5.9%
Ge many Obse ed 0 0 1 0 1
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 8.3% 0.0% 5.9%
G eece Obse ed 1 0 0 0 1
% wi hin ow 100.0% 0.0% 0.0% 0.0% 100.0%
% wi hin column 50.0% 0.0% 0.0% 0.0% 5.9%
I aly Obse ed 0 1 2 0 3
% wi hin ow 0.0% 33.3% 66.7% 0.0% 100.0%
% wi hin column 0.0% 50.0% 16.7% 0.0% 17.6%
Japan Obse ed 0 0 1 0 1
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 8.3% 0.0% 5.9%
Poland Obse ed 0 0 2 0 2
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 16.7% 0.0% 11.8%
Saudi A abia Obse ed 0 0 2 0 2
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 16.7% 0.0% 11.8%
Spain Obse ed 0 1 1 0 2
% wi hin ow 0.0% 50.0% 50.0% 0.0% 100.0%
% wi hin column 0.0% 50.0% 8.3% 0.0% 11.8%
Swi ze land Obse ed 0 0 1 0 1
% wi hin ow 0.0% 0.0% 100.0% 0.0% 100.0%
% wi hin column 0.0% 0.0% 8.3% 0.0% 5.9%
USA Obse ed 1 0 0 1 2
% wi hin ow 50.0% 0.0% 0.0% 50.0% 100.0%
% wi hin column 50.0% 0.0% 0.0% 100.0% 11.8%
To al Obse ed 2 2 12 1 17
% wi hin ow 11.8% 11.8% 70.6% 5.9% 100.0%
% wi hin column 100.0% 100.0% 100.0% 100.0% 100.0%
Pha macia 72: 1–12 9
The s udy “Psychological dis ess and well-being among
s uden s o heal h disciplines in Gene a, Swi ze land: The
impo ance o academic sa is ac ion in he con ex o ac-
ademic yea -end and COVID-19 s ess on hei lea ning
expe ience” aimed o in es iga e he psychological heal h
and academic sa is ac ion o s uden s in he con ex o
COVID-19 and yea -end s ess (T an e al. 2022). S an-
da dized scales o anxie y, dep ession, s ess, psychologi-
cal well-being, academic sa is ac ion, and an ad hoc scale
o s ess due o COVID-19 we e used. The pa icipan s
we e 433 i s - o hi d-yea s uden s in eigh di e en
heal h- ela ed acks. The s udy concluded ha academic
sa is ac ion played a mo e signi ican ole han s ess due
o COVID-19 in he lea ning p ocess. Educa ional ins i u-
ions should pay a en ion o he main ac o s ha can in-
c ease s uden s’ academic sa is ac ion by ensu ing ha hey
ha e con inuous and adequa e lea ning expe iences, as well
as access o psychosocial se ices ha help hem cope wi h
men al dis ess and imp o e hei psychological well-being.
Abou Hashish e al. conduc ed he s udy “The online
lea ning expe ience and epo ed headaches associa ed
wi h sc een exposu e ime among Saudi heal h scienc-
es s uden s du ing he COVID-19 pandemic.” The s udy
was conduc ed among a sample o 353 s uden s. Ques-
ionnai es we e used o collec da a on online lea ning,
sc een ime exposu e, and epo ed headaches. The e-
sul s showed ha s uden s we e mode a ely sa is ied wi h
online lea ning. Howe e , hey aced many challenges
ha a ec ed hei communica ion e ec i eness, and hey
p e e ed blended lea ning. The s udy ound a high p e a-
lence o headaches (65.72%) and long sc een ime among
he s udied s uden s (52.69%). The conclusion d awn om
he esul s is ha headaches a e a common heal h p ob-
lem among heal h sciences s uden s and can ha m hei
academic pe o mance and quali y o li e, especially in
ela ion o online lea ning. Blended lea ning app oaches
can imp o e s uden lea ning and pe o mance in heal h
sciences cou ses (Abou Hashish e al. 2022).
Ca pi e al., in hei s udy “Sleep Quali y and I s Associ-
a ions wi h Physical and Men al Heal h-Rela ed Quali y o
Li e among Uni e si y S uden s: A C oss-Sec ional S udy,”
in es iga ed he p e alence o poo sleep quali y and in-
somnia and examined he ela ionships be ween hese
ou comes, pe cei ed s ess, and heal h- ela ed quali y o
li e among I alian s uden s. An anonymous ques ionnai e
including he Pi sbu gh Sleep Quali y Index, Insomnia
Se e i y Index, Sho Fo m-12 Heal h Su ey, and Pe -
cei ed S ess Scale was adminis e ed o a sample o 1,279
s uden s a ending one o he la ges I alian uni e si ies.
In o al, 65% o he pa icipan s showed poo sleep quali-
y, and 55% epo ed symp oms o insomnia. S uden s e-
po ing poo sleep quali y and insomnia had highe sco es
on pe cei ed s ess and lowe sco es on physical and men-
al heal h- ela ed quali y o li e. The ela ionship be ween
sleep p oblems and quali y o li e is well documen ed, and
he COVID-19 pandemic appea s o ha e had an impac
on bo h sleep quali y and HRQoL. The s udy indings con-
i m he impo ance o sleep o college s uden s’ well-be-
ing and may in o m he de elopmen o heal h p omo ion
in e en ions o his popula ion (Ca pi e al. 2022).
“Quali y o li e, physical ac i i y, and bu nou synd ome
du ing he online lea ning pe iod in B azilian uni e si y
s uden s du ing he COVID-19 pandemic: a clus e anal-
ysis” is a s udy conduc ed by Azzi e al. (Azzi e al. 2022)
among B azilian s uden s, examining sociodemog aphic
da a, equency o physical ac i i y, a eas o s udy, bu nou
synd ome, quali y o li e, and pe cep ion o online lea n-
ing du ing he COVID-19 pandemic. Se en hund ed and
h ee s uden s (aged 17 o 62, om 67 highe educa ion
ins i u ions) pa icipa ed in he s udy. Th ee di e en p o-
iles o s uden s we e iden i ied in e ms o psychological
aspec s and pe cep ion o online lea ning. The i s p o-
ile, called he “Low Quali y o Li e” g oup, consis ed o
younge s uden s, mos ly women, wi h a highe equency
o psychological diso de s, in addi ion o highe bu n-
ou sco es, lowe quali y o li e, and wo se pe cep ion o
online lea ning. The second p o ile, called “In e media e
Quali y o Li e,” included pa icipan s wi h an a e age
age o 45 yea s, wi h a highe numbe o men who we e
ma ied, had child en, and we e wo king in addi ion o
s udying, and who had be e sco es o he pe cep ion
o online lea ning han he “Low Quali y o Li e” g oup.
The hi d p o ile, called “Be e Quali y o Li e,” included
s uden s wi h highe sco es in all a eas o quali y o li e
and a be e pe cep ion o online lea ning, wi h a highe
equency o physical ac i i y and lowe sco es o bu n-
ou synd ome. Medical s uden s showed highe sco es o
o e all quali y o li e. S uden s om exac sciences cou ses
showed highe sco es on all elemen s o he pe cep ion o
online lea ning compa ed o s uden s om o he cou ses.
The esul s o he su ey p o ide insigh in o he men al
heal h p o ile o s uden s, allowing educa ional manag-
e s o ou line speci ic coping s a egies o help s uden s
du ing he pandemic.
Be mejo-F anco and he eam in es iga ed gende di -
e ences in psychological s ess ac o s among physical
he apy s uden s du ing he COVID-19 pandemic. The
aim o he s udy was o in es iga e how he COVID-19
pandemic a ec ed he men al heal h and quali y o li e o
male and emale physical he apy s uden s a he Eu opean
Uni e si y o Mad id. The s udy was conduc ed online and
included a se o es s co e ing di e en domains: he 36-
i em Sho Fo m Heal h Su ey, he Six-i em s a e e sion
o he S a e-T ai Anxie y In en o y, he Accep ance and
Ac ion Ques ionnai e, he Th ee I ems Loneliness Scale,
he Fou -i em e sion o he Pe cei ed S ess Scale, he
Beck Dep ession In en o y e ised e sion, and he Sleep
Quali y Nume ic Ra ing Scale. A o al o 151 s uden s we e
included in he s udy, o which 78 we e emale and 73
we e male. Gende di e ences we e obse ed in mos o
he domains assessed. Female s uden s showed wo se le -
els o gene al heal h pe cep ion, quali y o li e, symp oms
o dep ession, anxie y, s ess, supp ession o expe iences
and psychological in lexibili y, sleep quali y, and loneliness
compa ed o male physical he apy s uden s. The esul s
o his s udy suppo he need o psychological in e -
