COVID-19: Health risk factors among students’ population in Albania

Covid-19 pandemic is one of the most impactful events that has happened at 21 st century. Changing the daily habits and facing serious health risks are common during this period of the pandemic, especially at the first year when the world population was unprepared. There have been different categories of people that suffered from such stressful impact. Student category also had a lot of difficulties in dealing with the changes and with severe health consequences. In this article there are described the complications Albanian students confronted during the first year of the pandemic. The study aimed to investigate mental health consequences on students and their ability to cope with the pandemic. This study is part of a longitudinal research with more data collected for an additional wave. Descriptive statistics are used to describe the evidence of depression rate, anxiety, and suicide ideation. Students were invited to compile an online questionnaire distributed on basis of a convenience sample. The outcome confirmed the hypothesis that on a psychological level there could have been some repercussions on student’s lifestyle, habits, and mental health. These results could lead to recommendations on how to build a better resilience to face properly the pandemic that is still ongoing.


I. Introduction
The pandemic of Covid -19 has brought into focus the mental health of the various populations affected by it. The prevalence of the epidemics emphasizes or create new stressors including fear and worry for familiars and relatives, restrictions on physical movement and social activities due to quarantine and immediate changes and radical lifestyle changes.
A recent review of viral outbreaks and pandemics documented stressors such as fear of infection, frustration, upset, insufficient information, financial loss and stigma. [1] (Brooks et al, 2020). Findings from recent studies show the increase in mental health issues among university or college students. According to the experts there is an urgent need to assess the effects of the current pandemic on the mental health and well -being of students. [2] (Holmes et al, 2020). The increased risk of health, strict preventive measures, and radical changes in the lifestyle of the students were reflected in their mental health and even in the quality of their sleep. Students were worried, also about the effects of COVID -19. [3] (XieJ, et al. (2021)).
According to the studies caried out in the first months of the pandemic time, students present increased rates of depression and severe anxiety, fear, and anxiety for realizing the requirements of the new educational reality. These findings were common among the female population. [4] (Halperin et al. (2021). The immediate change in the educational environmental of students, the quality of their education and other circumstances made students to experience unique challenges that negatively affecting their mental health. The lack of internships, campus jobs and other opportunities contributed to students' stress and declining their mental health.
According to a study realized from Dartmouth College, it was found that there were obvious differences in the behavior and mental health of students since the start of the pandemic and onward, with a high number of self-reported cases of depression and anxiety mainly in final exams. [5] (Wang et al 2018).
The student's mental health is an important issue of public health concern, requiring epidemiological data. Recent systematic reviews presenting evidence from primary research worldwide highlights the increase in psychological service costs associated with the COVID -19 pandemics. There is a growing resignation about the mental health of university students and the impact that undiagnosed and untreated students' mental illness. Unnormal stress and depression among students not only affects their performance but is also associated with increased self -harm and suicide attempts. [8] (Patsali, et al 2020). Chronic anxiety is associated with disability and lower academic achievement. The severity of the disability is further worsening when individuals engage in avoidance behaviors characteristic of people with anxiety. [9] (Hendriks, et al. 2016). It is important that colleges and universities accept and improve the safety system of mental health and psychological education and certainly provide students with the opportunity to get the help they need. [10] (E. T. Baloran, 2020

Procedure
The inclusion criteria specified that students over the age 18 years old could be recruited. Other criteria were about the Albanian language because the battery of questionnaires was translated in Albania and verified with the method of back translation. Also, it was specified that only students enrolled in universities could participate. There were no exclusion criteria for institutional enrollment. Students were recruited on a web-based survey. The participation was anonymous, and students were free to leave the questionnaire if they have no willingness to continue.

Data analysis
Descriptive statistics were performed to characterize the sample and to determine the levels of depressive symptoms, suicide thoughts and anxiety symptoms. Different analyses were performed, calculating mean, standard deviation, frequencies calculating age-groups, gender, level of education and personal income. Moreover, binary crosstabulation was performed analyzing gender and age group versus risk of depression, suicide ideation and generalized anxiety.

Nr valid 224
Nr missing 3

Minimum 18
Maximum 51      We must emphasize the fact that there was an extreme participation among women and an extremely negative participation among men where almost all participants were women 213/227 and only 5.3% of the sample were men.
Regarding the age group, there is a significant testimony from participants aged 18-29 years. It may be that the questionnaire was distributed mainly among university students. All other age categories were in total about 10% of the participants. 206 out of 27 were in the 18-29 age group.
The education level category can also be seen as related. Almost half of the participants had not yet graduated, about 50%. 56 out of 227 had received a bachelor's degree, 24.7% of the total. Interestingly, 22.9% of the respondents also obtained a Master's degree. Referring to the result where 206 out of 227 answered about personal income, with about 9% of the sample who did not answer and the main category includes personal income up to 500 euros/month, it is understood that social capital is significantly related to depressive symptoms and socio status -economic of the family. The results are an indication of the fact that students with low socio-economic perception, where 171 out of 206 respondents were part of this category, are more predisposed to exhibit depressive symptoms. These two data are consistent with previous studies that have shown a significant relationship between socio-economic capital and mental health related to the level of self-esteem 1 .
219 participants answered questions about the risk of depression, while 218 people answered questions about suicidal ideation and the category of generalized anxiety. These elements are presented as necessary for the protection of socio-

IV. Conclusions and Recommendations
The study confirmed a prevalence of depressive symptoms among students during the first year of the pandemic (44.5%).
Also, anxiety rates were present in more than 55% of participants. Besides, a relevant outcome were the high levels of suicidal thoughts (18,9%). Female partipants were at risk of depression in more than 43% of the cases, had 62,5% anxiety symptoms and 19% rate of suicidal ideation. These results confirm that students' population perceived anxiety and depression and high rates of suicidal thoughts. Moreover, high levels of education were evidenced among female participants and most of personal income were under 500 euro/monthly. The outcome of suicide ideation, depression and anxiety could be correlated with personal low incomes experienced during the pandemic with all economic activities closed. It could be remarkable to correlate the high level of education with depression, anxiety, and suicide ideation. It could be possible to speculate that the high level of education was associated with great expectation of job finding, a failed objective, stopped by the lockdown. Likewise, this could bring frustration among high educated people that was correlated with high rates of depression, anxiety, and suicide ideation.