Posted: February 26th, 2023

How has COVID-19 Affected Students Mental Health

5 pages high School level 

August 2021

Panel of Experts

Co-Chair Laura Hamilton, Educational Testing Service

Co-Chair Betheny Gross, WGU Labs

David Adams, The Urban Assembly

Catherine Pilcher Bradshaw, Curry School of Education at the University of Virginia

Pamela Cantor, Turnaround for Children

Robin Gurwitch, Duke

University

Robert Jagers, CASEL

Velma McBride Murry, Vanderbilt University

Marleen Wong, University of Southern California

How Has the Pandemic Affected Students’ Social-
Emotional Well-Being? A Review of the Evidence to Date

About this Series ……………………………………………………………………………………………………………………………………… 3

Overview ………………………………………………………………………………………………………………………………………………………… 4

Overview of Findings ……………………………………………………………………………………………………………………………. 6

What We Know ………………………………………………………………………………………………………………………………………. 6

What We Don’t Know …………………………………………………………………………………………………………………………. 6

What We Need to Know ……………………………………………………………………………………………………………………. 7

Mental Health and Well-Being ………………………………………………………………………………………………………. 7

Social-Emotional Development and Learning ……………………………………………………………………… 9

Implications for Post-Pandemic Recovery ……………………………………………………………………………. 11

Looking Ahead: Priorities for Research ……………………………………………………………………………………. 11

Conclusion ………………………………………………………………………………………………………………………………………………… 13

TABLE OF CONTENTS

CENTER ON REINVENTING PUBLIC EDUCATION

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

STATE ACCOUNTABILITY SYSTEMS IN THE COVID ERA AND BEYOND

CENTER ON REINVENTING PUBLIC EDUCATION3

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

About this Series
This report is part of a series that aims to provide a definitive account of the best
available evidence on how the COVID-19 pandemic has affected America’s students.
The series is part of a broader effort, the Evidence Project, which brings together
researchers and policymakers to advance solutions-oriented analysis of the K–12
response to the COVID-19 pandemic.

The Center on Reinventing Public Education compiled hundreds of studies and
convened panels of experts to interpret what the data show. Three initial reports
assess what we know to date about the pandemic’s effects on students’ academic
progress, its effects on their mental health and social-emotional well-being, and
its impact on students with disabilities. We will update these assessments and add
more topics over the coming year as new data become available.

We aim to present a coherent baseline of what we know, don’t know, and need to know
at this stage of the pandemic. These reports are designed to help system leaders,
community leaders, policymakers, researchers, philanthropies, the media, and others
to define ambitious goals and clear metrics that ensure our education system meets
every student’s needs over the coming years.

The series of papers will culminate in the release of CRPE’s first annual Profile of the
American Student. The report will provide a rigorous and nuanced assessment of 1)
how extensive student needs and inequities are across a variety of dimensions, 2)
how student needs vary across different dimensions and what that implies for policy
and practice, and 3) what promising solutions and innovations are emerging to meet
students’ needs.

In future years, these reports will track progress toward repaying every student the
educational opportunities they are owed after this traumatic and disruptive period.
Our goal is to provide an ongoing assessment of student needs and a look forward
toward restitution and recovery.

https://www.evidence-project.org/about

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I. Overview
The COVID-19 pandemic upended daily life for every family and school across the United States.
But its impacts were not universal. The inequities that cut across classrooms and communities
have contributed to broad disparities in the losses, trauma, and isolation that many students and
educators have endured. In addition, the converging social events of 2020–21, including protests
for racial justice, a contentious presidential election, and a riot at the Capitol, have challenged
young people to make sense of a turbulent era that few adults may yet fully understand.

In June of 2021, the Center on Reinventing Public Education (CRPE) gathered a panel of eight
experts in child development, adolescent mental health, and social-emotional learning to assess
and reflect on new research exploring the pandemic’s effects on student well-being, social-
emotional development, and ability to learn. In this paper, our panel situates these findings in
context and offers an agenda for researchers and practitioners to work from in the years ahead.

Panel of Experts

Co-Chair Laura Hamilton, Associate Vice President for Research Centers, Educational Testing Service

Co-Chair Betheny Gross, Research Director, WGU Labs

David Adams, CEO, The Urban Assembly

Catherine Pilcher Bradshaw, Professor and Associate Dean for Research and Faculty Development, Curry
School of Education at the University of Virginia

Pamela Cantor, Founder and Senior Science Advisor, Turnaround for Children

Robin Gurwitch, Professor, Department of Psychiatry and Behavioral Sciences, Duke University

Robert Jagers, Vice President of Research, CASEL

Velma McBride Murry, Lois Audrey Betts Chair in Education and Human Development, University
Professor of Human and Organizational Development, and University Professor of Health Policy, Vanderbilt

University

Marleen Wong, David Lawrence Stein/Violet Goldberg Sachs Professor of Mental Health at University of
Southern California

A Shock to Student Lives

The pandemic affected the lives and social-emotional experiences of every student to some
extent. Along with the unprecedented closures of schools across the country in March 2020,
virtually all social activities ceased. Students were cut off from their teachers, with uneven
access to live instruction and hands-on, collaborative learning. There were few opportunities to
see friends in person or engage in extracurricular activities. At the same time, many students
also were contending with the pandemic’s frightening impacts on their family’s health and
welfare, such as illness, the death of a relative or neighbor, and economic hardship. Some
students also took on new responsibilities to care for younger siblings or contribute to family
finances.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

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The human losses and financial tolls were more commonly experienced by Black, Hispanic/
Latinx, and indigenous students from lower-income communities. One survey found 41 percent
of these young people reported providing care for someone else in their household and 62
percent reported being financially affected by the pandemic. These students also were more
likely to be separated from in-person schooling for longer periods of time. In May 2021—some
14 months after the start of the pandemic—just 47 percent of high-minority school districts
were operating fully in person compared to 61 percent of low-minority districts. In addition,
chronic absenteeism is thought to have risen dramatically, especially among students of color,
though attendance record-keeping was not consistent.

Not every student’s experience was wholly negative. Some families transitioned to remote
learning and work with relative ease—enjoying more unscheduled time together and even
boosting their economic security during long months at home. Some students reported they
preferred remote learning as a means to avoid social stresses or racial microaggressions they
encountered at school. And some students undoubtedly developed resilience and thrived in
ways that they would not have in the absence of the events of 2020 and 2021.

Fast-Moving Research in Tumultuous Times

Over the past year, researchers have worked faster than ever before to collect and analyze
data on the experiences of young people. As a result, the field has a substantial account of the
pandemic and its likely implications for youth. But students’ experiences were vastly different
from one another during this time, based on their proximity to illness and loss, gender and race,
age, and length of school closures, among other factors. One of the biggest areas of concern
is the extent to which contextual variations between those experiences will affect individual
development over the longer term.

This leads to a note on the scope of this report. While the factors contributing to students’
mental health and social-emotional development are expansive, our panel focused on the
research exploring the effects of the pandemic and school closures on children and young
people in grades K–12 in the U.S. We recognize that long-standing structural racism shaped
the pandemic’s impact in meaningful ways, and that a nationwide reckoning over that reality
has affected student well-being and development. This review does include research that
considers racism’s effects in the context of the pandemic; however, far more can be examined
and discussed than reflected here. We believe these issues should be considered in their full,
complex, and essential breadth.

In addition, we acknowledge that the pandemic has taken a significant toll on adult caregivers
and educators. Parents who may have been juggling their own fears of illness or economic
hardship have had to step in as teachers to support young learners throughout the school day.
Meanwhile, teachers were adapting instruction to fit often unfamiliar technological platforms
while attempting to build and foster nurturing relationships with students they’d never met in
person. A survey in late 2020 found that 78 percent of teachers reported frequent job-related
stress and 27 percent said they were depressed, compared to average rates of 40 percent
and 10 percent, respectively. While these adult issues are beyond the scope of this report, the
well-being of families and educators should also be a significant area of focus as young people
return to the classroom full-time.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

https://www.equitablefutures.org/wp-content/uploads/2021/03/Memo_BMGF-Youth-Survey-W3-Findings_v020321

CDC Masks

https://www.edweek.org/technology/extreme-chronic-absenteeism-pandemic-school-attendance-data-is-bleak-but-incomplete/2021/07

https://www.rand.org/pubs/research_reports/RRA1108-1.html

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What the Research Says So Far

Our main findings reveal widespread impacts on students’ mental health, while the effects of
the pandemic on social-emotional development are less understood. More than anything, our
panel felt that the pandemic revealed how inadequately we serve students’ mental health and
social-emotional development in normal times.

The review also uncovered an urgent need for more effective social-emotional learning
opportunities and innovative approaches to expand student supports. This calls for an integrated
and responsive system of education and tailored supports, one that can flexibly meet each
individual student’s highly variable needs on an immense, post-pandemic scale.

To inform this recovery work, our panel summarized the main research findings to date, explored
what those findings tell us about student mental health and social-emotional learning, and
identified the pressing questions still in need of answers. Looking ahead, researchers should
focus on how schools and leaders can partner with community-based sources of support
and stability, how race factors into students’ experiences and well-being, and how to more
comprehensively define and measure school and student success.

II. Overview of Findings
What We Know

• A significant portion of young people, likely 30 to 40 percent, have experienced negative
impacts on their mental or social-emotional health during the pandemic.

• Students who learned remotely for long periods of time and historically marginalized
students were more likely to experience these negative effects.

• Rates of anxiety and attempted suicides, already on the rise pre-pandemic, appear to
have increased among all students, especially among girls.

• While some students fared well initially, or even fared better when learning remotely
than they did in person before the pandemic, these positive effects did not last. Negative
effects for students increased over time.

• Schools and districts, especially in rural areas without a strong social-service infrastructure,
lacked systems to track student well-being or strategies to address and improve it.

What We Don’t Know

• Anecdotal evidence suggests that students with disabilities were disproportionately
affected by the pandemic. Some families reported that their children went months
without receiving their legally mandated therapies. Despite this, no surveys specifically
examined the mental health and well-being of students with disabilities

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

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• Most research efforts focused on adolescent students. We have little clear evidence on
the pandemic’s impact on the well-being of children ages 5 to 10.

• There is almost no systematic data that detailed the pandemic’s impact on students’
social-emotional development. Some students reported that they had gained skills in
time management and self-direction. However, teachers reported a concerning lack of
student motivation and engagement in learning.

What We Need to Know

• The ways in which a young person’s unique surroundings, learning environment, and
developmental stage shaped their experiences during the pandemic.

• Which combinations of supports and interventions will help students recover and regain
their mental health, well-being, and age-appropriate social-emotional competencies,
based on their highly varied experiences of the pandemic.

• What innovations and opportunities exist and emerged to provide a more comprehensive
and robust continuum of support in schools.

• How to effectively coordinate and mobilize families, community members, and
community-based organizations to support students outside school.

• How to measure and monitor mental health, well-being, and social-emotional learning
opportunities and outcomes to inform decision-making.

Mental Health and Well-Being

Our panel reviewed the research on student mental health and well-being and social-emotional
competencies during the pandemic with two major questions in mind. First, what were the
reported effects of the pandemic on students? And second, what services and supports did
students receive at or through their schools?

Findings on Effects of the Pandemic

The pandemic’s initial effects on young people’s mental health and well-being were first
documented in surveys administered shortly after school closures began. In a nationally
representative survey of 13- to 19-year-olds in April 2020, 36 percent reported that they were
more concerned than usual about their own emotional health. Upwards of 40 percent reported
negative effects on a host of cognitive and emotional health markers, including their ability to
concentrate, make decisions, and feel happy. However, a separate study of 2,000 adolescents
in five schools during the first two months of school closures did not find elevated markers
of clinical depression or anxiety relative to 2019. In fact, reported rates were slightly lower
overall—possibly related to relaxed schedules and lesser demands for academic performance.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.americaspromise.org/sites/default/files/d8/Updated%20Appendix

https://www.cambridge.org/core/journals/development-and-psychopathology/article/risk-and-resilience-during-covid19-a-new-study-in-the-zigler-paradigm-of-developmental-science/C8E57B185D31C454ECD2E02D4B8D90D8

https://www.cambridge.org/core/journals/development-and-psychopathology/article/risk-and-resilience-during-covid19-a-new-study-in-the-zigler-paradigm-of-developmental-science/C8E57B185D31C454ECD2E02D4B8D90D8

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Surveys of caregivers consistently uncovered broad concerns about their children’s well-being.
In a national survey in June 2020, 14 percent reported “worsening behavioral health” for their
children. And a survey of more than 32,000 caregivers in Chicago found more frequent reports
of negative concerns and behaviors, such as incidents of self-harm, suicidal ideation, expressions
of loneliness, and less frequent reports of positive behaviors or expressions, such as making
plans for the future and having positive peer relationships.

An analysis of emergency room visits among young people ages 11 to 21 found significantly
higher rates of suicidal ideation and suicide attempts after the pandemic began, though the
overall rate of suicides remained consistent with previous years. The Centers for Disease Control
(CDC) reported that, among young people ages 12 to 17, the proportion of emergency room
visits related to mental health increased by 31 percent in 2020 compared to 2019. The CDC also
found dramatic increases in the number of suspected suicide attempts among girls ages 12 to 17.
Compared to before the pandemic, suspected attempts were 27 percent higher in late summer
2020; by March 2021, a year after schools were first closed, that number was 51 percent higher.

Survey research also showed that the pandemic affected young people to different degrees
and in different ways. Many young people, and even a plurality in some surveys, reported that
their mental health and social-emotional conditions were unchanged. However, in surveys
that considered differential impacts, negative effects were more pronounced for girls and for
young people from marginalized groups, including immigrants, LGBTQ youth, young people
of color, and those living in low-income households. Racism in schools predates the pandemic
but remained unrelenting during the pandemic and shaped the experiences of young people.
Anecdotal accounts suggest that some Black parents found that remote learning gave their
children a break from the daily effects of racism, with some reporting that they may keep their
children in homeschool or remote learning after the pandemic.

Survey findings shifted as time wore on. The pandemic surged over the summer, racial protests
stemming from the murder of George Floyd took hold across the country, and debates about
how to safely return to school dug in. As the fall set in, about half of students nationwide and
most students in urban settings continued with remote learning. Surveys administered later in
2020 suggested that these events were taking an increasing toll on young people’s well-being.

A fall 2020 survey found that, relative to the spring, more students felt they had been personally
affected by the pandemic. The protests for racial justice also weighed on their minds. In a
survey of students from low-income households and students of color, two-thirds reported
“paying a great deal of attention” to the protests for racial justice that played out through the
summer and fall of 2020. Students identified feeling “depressed, stressed, or anxious” as the
primary obstacle to learning.

Remote learning itself emerged as a source of stress for some students. Survey results indicated
that remote learning improved in the fall, with the share of students reporting that they learned
“a lot” every day at 61 percent—back to pre-pandemic levels. Nonetheless, in a survey of
educators and school leaders, teachers were asked to categorize possible sources of support as
a “major” or “minor” need. A greater share—45 percent—identified “strategies to keep students
engaged and motivated to learn remotely” as a major need compared to any other source of
support. And in a survey of students at a large high school that offered remote and in-person

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://pubmed.ncbi.nlm.nih.gov/32709738/

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779300?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=042921

https://pediatrics.aappublications.org/content/147/3/e2020029280

https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm?s_cid=mm7024e1_w

https://www.thetrevorproject.org/survey-2021/

https://www.chicagotribune.com/coronavirus/ct-aud-nw-black-students-racism-remote-learning-20210504-yhycne3n7fdgpjdxtnavmn7yqq-story.html

https://www.chicagotribune.com/coronavirus/ct-aud-nw-black-students-racism-remote-learning-20210504-yhycne3n7fdgpjdxtnavmn7yqq-story.html

Students Weigh In, Part II: Learning & Well-Being During COVID-19

https://www.equitablefutures.org/wp-content/uploads/2020/09/Equitable-Futures-COVID-19-Youth-Tracking-Poll-Findings-Brief-Sep-2020

https://www.rand.org/pubs/research_reports/RRA168-2.html

https://www.rand.org/pubs/research_reports/RRA168-2.html

https://psyarxiv.com/rpz7h/

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instruction, students who continued in remote learning reported greater declines in their social-
emotional well-being. These declines were consistent across gender, race and ethnicity, and
socioeconomic status, and were particularly notable in older youth.

Findings on School-Based Supports

After school buildings were abruptly closed, students reported a dramatic drop in their access
to teachers, and sense of belonging in their school. During this time, most districts reported
that they were attempting to continue to offer counseling and other sources of support for
student well-being. However, student access to those supports varied widely. While larger,
well-resourced districts had crisis teams at the ready, smaller districts, districts in rural and
small-town locales, and those serving a large share of students living in poverty had fewer
resources to support well-being.

Many students reported that they felt supported by teachers or resources in their schools.
In surveys administered in six Tennessee districts, 96 percent of students reported that they
felt their teacher cared about them. A national survey of more than 60,000 students found
greater numbers reported having access to programs and services to help when they were
feeling upset, stressed, or having problems: 43 percent, compared to 37 percent pre-pandemic.
However, just 41 percent of students said there was an adult from school they could talk to
about their problems during the pandemic, compared to 46 percent in 2019.

Social-Emotional Development and Learning

Limits on in-person learning also had an effect on school’s opportunity to support students’
social-emotional development.

In this discussion, we define as “social-emotional development” the broad set of competencies
and skills that support student success in school and in life, such as persistence, self-awareness,
skillful communication and collaboration with peers, and self-regulation. When we refer to
“social-emotional learning” (SEL), we mean the learning activities, instruction, and experiences
that are designed to help students practice and develop those competencies. While local
definitions can vary, we share here the common understanding developed by CASEL, which is
also sometimes referred to as “21st Century skills,” in use at many districts:

SEL is the process through which all young people and adults acquire and apply the
knowledge, skills, and attitudes to develop healthy identities, manage emotions and achieve
personal and collective goals, feel and show empathy for others, establish and maintain
supportive relationships, and make responsible and caring decisions.

Impacts on Social-Emotional Development

We found very little data that directly measured changes in students’ social-emotional
competencies during the pandemic. Hopefully, in time, data from student surveys that capture
these competencies will fill in the picture.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

Students Weigh In, Part II: Learning & Well-Being During COVID-19

https://www.air.org/sites/default/files/Social-Emotional-Supports-for-Students-During-COVID-19-Feb-2021

https://peabody.vanderbilt.edu/TERA/covid19_fall_semester_trends.php

http://youthtruthsurvey.org/wp-content/uploads/2021/02/YouthTruth-Students-Weigh-In-Part-II-Learning-and-Well-Being-During-COVID-19

https://casel.org/what-is-sel/

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To date, subjective assessments in educator surveys are our best sources of information. In a
February 2021 survey of school district leaders, 77 percent reported that their students had
fallen behind in their social-emotional development compared to two years earlier.

In a nationally representative survey of teachers in May 2020, 33 percent reported being
concerned about students’ social-emotional health, placing this worry second only to academic
decline. Some 46 percent said they were spending “somewhat” or “much more” time giving
students social-emotional support, and more than 60 percent had heard students express
social-emotional concerns because of the pandemic.

A fall 2020 study of six Tennessee districts found that, while students felt supported by their
teachers, many struggled with motivation and engagement. Three-quarters of K–12 students
reported that being worried or stressed made it hard to do their best in school. Some 59 percent
of elementary school teachers and 71 percent of high school teachers named “strategies to
keep students engaged and motivated” as a major or moderate need.

Attendance data is another potential source of information about students’ social-emotional
development, though record-keeping and data collection has not been consistent during the
pandemic. The Tennessee study found that rates of chronic absenteeism more than doubled
for virtual students, from 12 percent in 2019–20 to 27 percent in 2020–21. In a nationally
representative fall 2020 survey of educators, respondents reported that daily absence rates
had more than doubled from the year before. Districts in Massachusetts and California also
have reported elevated rates of chronic absenteeism.

Meanwhile, teachers’ reports of student engagement, including activities that call on key social-
emotional competencies, showed broad declines. For example, in the fall 2020 teacher survey,
67 percent reported student work habits, as evidenced by assignment completion rates, were
“somewhat” or “much” worse than before. However, other anecdotal evidence suggests that
some students benefited from more flexible and less distracting learning arrangements. Self-
paced, independent learning models enabled some students to develop individual agency, self-
advocacy, and time-management skills.

Opportunities for Social-Emotional Learning

School closures curtailed in-person opportunities for students to build relationships, work
collaboratively with peers, and receive and act on feedback from teachers—all of which
contribute to social-emotional development in youth. Educators and families attempted to
at least partially restore these opportunities in the 2020–21 school year for students whose
school remained hybrid or fully remote. Teachers scheduled regular check-ins with students,
led virtual mindfulness exercises, and organized group projects online, while parents organized
“pandemic pods” or other small in-person learning communities. Little is known yet about the
effectiveness of these alternatives.

As part of an ongoing project looking at trends during the pandemic, CRPE studied how social-
emotional learning and student well-being featured in the fall 2020 reopening plans of 477
school districts across the United States. Our report found that socialemot-ional learning was a
notable priority: it was included in 66 percent of district plans overall, and 87 percent of plans
in urban districts. However, those plans were more focused on safety than competency-focused

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.rand.org/pubs/research_reports/RRA956-2.html

https://e4e.org/sites/default/files/voices_from_the_virtual_classroom_2020

https://peabody.vanderbilt.edu/TERA/files/covid19_fall_semester_trends_FINAL

https://www.edweek.org/leadership/in-person-learning-expands-student-absences-up-teachers-work-longer-survey-shows/2020/10

https://www.wbur.org/edify/2021/05/05/massachusetts-pandemic-schools-absences

‘The Numbers are Ugly’: Chronic Absenteeism Among California Elementary Students Could Be Surging by More Than 200 Percent

Remote learning has been a disaster for many students. But some kids have thrived

https://www.crpe.org/publications/how-are-school-districts-addressing-student-social-emotional-needs-during-pandemic

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social-emotional learning. Overall, 47 percent of all plans mentioned safe and supportive
environments, while 31 percent mentioned building social-emotional skills. In addition, just 7
percent of district plans include collecting data.

Overall, urban and suburban districts have been more likely to expand or add programs
that support social-emotional learning. Some 56 percent of district leaders reported adding
programs during the pandemic, according to the February 2021 survey. Among leaders of
urban districts, that figure was 69 percent. Just 50 percent of rural district leaders reported
adding social-emotional learning programs at their schools.

III. Implications for Post-Pandemic Recovery
Looking Ahead: Priorities for Research

All eyes are now focused on recovery, with federal relief funds on the way. The key will be to
target those resources and schools’ efforts to their most effective ends. For that, we need to
know much more. Our panel identified four priorities for research and recovery: differences
in student background and experiences, innovative approaches to promoting well-being, the
roles of race and community assets, and new strategies for assessment.

Priority No. 1: Develop a deeper and more complex understanding of the differences among
student experiences, including those of students at different developmental stages, with diverse
backgrounds, or who experienced positive growth amid adversity.

Research has shown that, as children age, their mental health and well-being competencies and
outcomes change. As such, the nature of these competencies and how we accurately measure
them must be attuned to students’ developmental stages. Yet studies from the last year did
little to account for differences by age or the contexts in which children and young people
live and learn. Young children in primary grades undoubtedly experienced remote learning
and any personal negative impacts from the pandemic differently than middle or high school
students. But many student surveys clustered children from middle and high schools together,
and parent surveys failed to distinguish between families with adolescent or younger children.

These developmental differences will also shape how individual students experience the
recovery period, including their response to different interventions and strategies to support
them. Future research must take this into account.

Similarly, research from the past year offers only a very limited view of how the pandemic,
measures to control it, and other concurrent social events—such as ongoing protests for social
justice—affected children and young people from different backgrounds or communities, or
those learning in different school settings. One panelist commented, “Most of the research
is based on white, middle-class perspectives. The question that I’m interested in is, does it
look the same for an immigrant Latino child to say that they are functioning well socially and
emotionally? What about a kid in a rural community?”

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.rand.org/pubs/research_reports/RRA956-2.html

https://www.ncbi.nlm.nih.gov/books/NBK32792/

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Several studies disaggregate data based on student race, ethnicity, or economic status but few
consider more complex intersections of identity and context. For example, no studies tried to
understand how Black children in rural and urban communities experienced the year differently.
Moreover, most of the reporting of results presented averages or focused on the most frequent
experiences or responses. Few looked closely at the children whose experiences or responses
were atypical. If they had, we may have a better understanding as to why some families are not
eager to return to in-person classrooms.

Finally, the panel noted that the research focused on what children and young people lost
this year. This narrative of loss, however, overlooked the complex ways that children react to
adversity. Even amid personal hardship or tragedy, young people can and, and often do, grow,
learn, and become stronger.

Framing student experiences in terms of what they lost “doesn’t allow for the fact that children
and adults discover their assets at times like this,” said one panelist. “We need to think more in
terms of the variation and adaptation to an unbelievable situation, and what young people and
the adults working with them will discover going through something like this.”

In addition, there were some initial benefits from school and workplace closures. At first,
unsettling as sudden closures were, some families enjoyed new, slower schedules and increased
opportunities to renew their connections. But over time, the closures became more stifling and
their negative effects grew. Understanding how any experience can have complex, changing
consequences for children is just as important to understand as how the same experience can
have different implications for different children.

The panelists would like the field to dramatically advance understanding of how different
student experiences can be, even given the same circumstances, and how an individual child’s
unique contexts at home and in school can shape the consequences of those experiences. In
particular, they hope to see research on:

• How the contexts surrounding young people interact with children’s identities, including
their self-image and how others view them, as well as which resources and supports are
available to support well-being and social-emotional development.

• The ways in which the pandemic’s challenges presented opportunities for students to
build resilience, coping strategies, independence, and agency, including the characteristics
of students, families, communities, learning environments, and instructional approaches
that accompany and predict such growth.

• How the pandemic’s effects differed for children and young people at different
developmental stages.

• How schools can best design strategies to account for developmental as well as context
variation to support children in the coming year.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

STATE ACCOUNTABILITY SYSTEMS IN THE COVID ERA AND BEYOND

CENTER ON REINVENTING PUBLIC EDUCATION13

Priority No. 2: Identify innovations that can dramatically improve student social-emotional
learning and help schools meet students’ mental health needs.

All children and young people need opportunities for social-emotional learning and
development. Just as physical education promotes healthy lifestyle choices with long-
term health benefits, one panelist explained, social-emotional learning helps students build
foundational skills to navigate life, such as self-knowledge, resilience, and collaborative problem-
solving. Last year’s experience made clear that social-emotional competencies are crucial—
as developmental goals in their own right that support mental health and well-being and as
important contributors to student success.

The pandemic also revealed just how many young people need mental health services to
address serious concerns. School closures dramatically illustrated the extent to which students
rely on their schools to access trusted relationships with adults and peers, as well as a broad
array of mental health and social services. Yet for the most part, schools have not been given
the resources or staff to provide an extensive continuum of support.

The panel noted an urgent need to better understand how schools and other providers can
provide such support to every student at a much larger scale, without simply adding more
counselors and social workers. In particular, they hope to see research on:

• Technology that supports personalized engagement, including which tools and supports
educators need to effectively put it to use and strategies to implement such tools at
scale.

• Whether and in what ways the alternative learning environments that emerged or
expanded during the pandemic, such as pods and hybrid schedules, create opportunities
for adults and peers to build deeper relationships, nurture social-emotional development,
and foster youth agency.

• Partnerships and funding models that join schools with health care providers, community
organizations, and other family and social support structures to provide the continuum
of support.

• Training and development to ensure educators are prepared to work alongside
counselors in helping meet student needs and serve as a powerful part of the “protective
layers” of support that help children who are exposed to traumatic events.

Priority No. 3: Investigate ways to leverage community assets and acknowledge the role of
race in communities and student experiences.

During the pandemic, many students spent their days learning at home or at a neighborhood
site. The power and potential of these home- and community-based resources to support young
people’s well-being and social-emotional development was clear. Several panelists noted that
communities rallied to support families and young people during the initial shutdowns and
then, in several towns and cities, went on to create highly organized systems of learning and
support.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.psychologytoday.com/us/blog/hope-resilience/202012/rebuilding-the-layers-protect-children-s-mental-health

https://www.psychologytoday.com/us/blog/hope-resilience/202012/rebuilding-the-layers-protect-children-s-mental-health

STATE ACCOUNTABILITY SYSTEMS IN THE COVID ERA AND BEYOND

CENTER ON REINVENTING PUBLIC EDUCATION14

A review by CRPE found that 36 percent of the largest U.S. cities operated or sponsored
learning pods during the pandemic. For example, Tulsa’s City of Learning coordinated, provided
technical support, and publicized learning, enrichment, and social programs for city students
through local schools and a network of more than 80 community partners.

Yet one panel member noted that the field has not consistently or systematically considered the
potential for these resources to provide supportive structures for young people. One panelist
lamented that even “[caregivers] have been relegated to a minor role in helping to develop
educational experiences.”

Panelists also noted the important role that race plays in influencing community culture and
student identity, both of which are important assets and sources of stability and emotional
strength for young people. They noted, as well, how enduring structural elements of racism
embedded in the ecosystem undermine the best efforts to support students. Racism takes a
well-established toll on mental health and well-being.

Engaging the ecosystem to support young people, particularly Black, Hispanic, and indigenous
youth, is fertile ground for continued research. In particular the panel would like to see
researchers explore:

• New roles for caregivers in supporting social-emotional development and learning,
including the supports and teacher relationships families need to fully play this role.

• Strategies to ensure all adults in all learning settings understand and can apply existing
knowledge of effective learning environments in their daily practice.

• Emergent innovations in community-based programming to support youth, including
their origins, reach, and impact.

• Implementing non-stigmatizing approaches to mental health intervention at a large
scale.

• The many manifestations of racism in communities and their impact on the well-being
of students.

• Emergent school-based efforts to dislodge the systems and policies that perpetuate
racism in local communities, including partnerships with families and community-based
organizations.

Priority No. 4: Reimagine measurement.

Addressing the disruption and trauma that resulted from the pandemic will require
comprehensive and varied approaches to supporting students academically, socially, and
emotionally. These approaches must be informed by an understanding of each student’s
history, context, current needs, and hopes for the future. Moreover, this work must be carried
out in a way that contributes to greater equity of opportunities for all students. It is hard to
imagine that educators and others who support youth will be able to accomplish this ambitious
set of goals without high-quality measurement tools. Such tools can be used to understand the
contextual factors affecting students, monitor access to supportive learning opportunities, and
track student progress.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.crpe.org/publications/covid-19-revealed-new-roles-cities-create-continuum-support-youth-and-families-they

Home

https://www.apa.org/pi/oema/resources/ethnicity-health/racism-stress

STATE ACCOUNTABILITY SYSTEMS IN THE COVID ERA AND BEYOND

CENTER ON REINVENTING PUBLIC EDUCATION15

Current assessment and data collection approaches used to monitor learning opportunities
and outcomes are not up to the task. Large-scale assessments of academic achievement are
limited to a small number of subjects—and even within those subjects, they measure a narrow
range of skills. Further, they typically are not aligned with all students’ sociocultural contexts
and therefore offer limited information about student learning. Relatively few large-scale
assessments have been validated for the purpose of measuring students’ social-emotional
competencies, and we also lack measures that would help us understand how students have
coped with the many challenges they have encountered. Additionally, because remote learning
is likely to remain in place at least some of the time for many students, assessments must
accommodate both in-person and remote administration.

Simply measuring student learning is not sufficient. Without some effort to ensure that users
of that student achievement data understand the factors that might have contributed to
outcomes, we run the risk of misinterpretation and stigma, especially when disparities across
subgroups are large. We cannot make sound decisions about interventions and support without
accounting for the impact of students’ circumstances. Data on learning must be accompanied
by data on students’ opportunities to learn through formal schooling as well as information on
their broader sociocultural context.

A recent report on monitoring educational equity pointed out the need for multiple measures of
outcomes and learning opportunities to understand and address disparities. And as one panelist
noted, “The more completely we make the effort to understand (vs. assume) the variation in
context children are experiencing, the more meaningful the interpretation we can give to the
data we are reporting.” In particular, the panelists want to see researchers and practitioners in
the field develop:

• A framework and measures for capturing information about opportunity to learn
(OTL), broadly defined to include access to high-quality instruction and supports, both
in-person and remote, and both in and out of schools. Evidence regarding available
academic and social-emotional learning opportunities is a crucial step to address
differences in learning outcomes.

• Measures of climate and relationships in both in-person and remote contexts. As several
panelists noted, supportive relationships and positive climate are crucial for student well-
being, but commonly used measures of these constructs were developed primarily for
in-person schooling.

• Systematic efforts to document sociocultural context, including exposure to racism and
to stressors in the home.

• Developmentally and socioculturally appropriate measures of student social-emotional
learning and well-being that can be used to guide schools’ efforts to provide student
supports.

• Measures of educator well-being to inform the provision of supports for educators.

• Guidance for teachers and other school personnel to use data on OTL, social-emotional
learning, and well-being to effectively support students.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

https://www.nap.edu/catalog/25389/monitoring-educational-equity

STATE ACCOUNTABILITY SYSTEMS IN THE COVID ERA AND BEYOND

CENTER ON REINVENTING PUBLIC EDUCATION16

Conclusion

Students have been deeply affected by the pandemic, including by sudden—and in many
cases—lengthy separations from their school communities. Recovering from this long-term
crisis calls for a comprehensive approach. Schools must provide necessary mental health
supports and opportunities to regain and enhance social-emotional competencies, while also
working to connect student communities and caregivers to form a cohesive system of support
at home and at school. Researchers should investigate and identify promising ways to build a
strong, engaging, and interconnected system of education and supports that fosters the social-
emotional development, mental health, and well-being that all students need to thrive.

About the Center on Reinventing Public Education

CRPE is a nonpartisan research and policy analysis center at the University of Washington
Bothell. We develop, test, and support bold, evidence-based, systemwide solutions to address
the most urgent problems in K–12 public education across the country. Our mission is to reinvent
the education delivery model, in partnership with education leaders, to prepare all American
students to solve tomorrow’s challenges. Since 1993 CRPE’s research, analysis, and insights
have informed public debates and innovative policies that enable schools to thrive. Our work is
supported by multiple foundations, contracts, and the U.S. Department of Education.

HOW HAS THE PANDEMIC AFFECTED STUDENTS’ SOCIAL-EMOTIONAL WELL-BEING?

Supplement

16 MMWR / April 1, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

Mental Health, Suicidality, and Connectedness Among High School
Students During the COVID-19 Pandemic — Adolescent Behaviors

and Experiences Survey, United States, January–June 2021
Sherry Everett Jones, PhD1; Kathleen A. Ethier, PhD1; Marci Hertz, MS1; Sarah DeGue, PhD2; Vi Donna Le, PhD2; Jemekia Thornton, MPA1;

Connie Lim, MPA1; Patricia J Dittus, PhD1; Sindhura Geda, MS3

1Division of Adolescent and School Health, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC;
2Division of Violence Prevention, National Center for Injury Prevention and Control, CDC; 3ICF International, Rockville, Maryland

Corresponding author: Sherry Everett Jones, PhD, National Center
for HIV, Viral Hepatitis, STD, and TB Prevention, CDC. Telephone:
404-718-8288; Email: sce2@cdc.gov.

Abstract

Disruptions and consequences related to the COVID-19 pandemic, including school closures, social isolation, family economic
hardship, family loss or illness, and reduced access to health care, raise concerns about their effects on the mental health and
well-being of youths. This report uses data from the 2021 Adolescent Behaviors and Experiences Survey, an online survey of a
probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705), to
assess U.S. high school students’ mental health and suicidality during the COVID-19 pandemic. The study also examines whether
mental health and suicidality are associated with feeling close to persons at school and being virtually connected to others during the
pandemic. Overall, 37.1% of students experienced poor mental health during the pandemic, and 31.1% experienced poor mental
health during the preceding 30 days. In addition, during the 12 months before the survey, 44.2% experienced persistent feelings
of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide. Compared with
those who did not feel close to persons at school, students who felt close to persons at school had a significantly lower prevalence
of poor mental health during the pandemic (28.4% versus 45.2%) and during the past 30 days (23.5% versus 37.8%), persistent
feelings of sadness or hopelessness (35.4% versus 52.9%), having seriously considered attempting suicide (14.0% versus 25.6%),
and having attempted suicide (5.8% versus 11.9%). The same pattern was observed among students who were virtually connected
to others during the pandemic (i.e., with family, friends, or other groups by using a computer, telephone, or other device) versus
those who were not. Comprehensive strategies that improve feelings of connectedness with others in the family, in the community,
and at school might foster improved mental health among youths during and after the COVID-19 pandemic.

Introduction
Emerging data suggest that the COVID-19 pandemic has

negatively affected the mental health of many children and
adolescents (1). Before the pandemic, youth mental health was
already an important public health concern (2,3). For example,
among high school students nationwide, significant increases
occurred between 2009 and 2019 in having persistent feelings
of sadness or hopelessness (26.1% to 36.7%), having seriously
considered attempting suicide (13.8% to 18.8%), and having
attempted suicide (6.3% to 8.9%) (2). For many youths during
the pandemic, mental health was affected by school closures,
social isolation, family economic hardship, fear of family loss or
illness, and reduced access to health care because of inadequate
insurance coverage or medical office closures and reduced
hours (1). Two longitudinal studies on adolescent mental

health during the pandemic found increases in depression
and anxiety over the course of the pandemic (4,5). In one
study, these symptoms were predicted by COVID-19–related
worries, online learning difficulties, and increased conflict
with parents (4). In another study, emergency department
visits for suspected suicide were 50.6% higher among girls
and 3.7% higher among boys from February through March
2021 than during the same period in 2019 (6). To understand
the impact of COVID-19 on youth mental health and to
identify potential protective factors, this study examines U.S.
high school students’ mental health and suicidality during
the COVID-19 pandemic, including the relation between
mental health and connectedness to school, family, friends, and
community groups. Public health and health care professionals,
communities, schools, families, and adolescents can use these
findings to better understand students’ mental health and
suicidal thoughts and attempts during the pandemic and how
fostering connectedness at school and with others could be one
strategy to promote adolescent health and well-being during
the pandemic and beyond.

mailto:sce2@cdc.gov

Supplement

MMWR / April 1, 2022 / Vol. 71 / No. 3 17US Department of Health and Human Services/Centers for Disease Control and Prevention

Methods

Data Source
This report includes data from the Adolescent Behaviors and

Experiences Survey (ABES), which was conducted by CDC
during January–June 2021 to assess student behaviors and
experiences during the COVID-19 pandemic. ABES was a
one-time, probability-based online survey of U.S. high school
students. ABES used a stratified, three-stage cluster sampling
approach to obtain a nationally representative sample of public-
and private-school students in grades 9–12 in the 50 U.S. states
and the District of Columbia (N = 7,705). Participation in
ABES was voluntary; each school and teacher decided whether
students completed the survey during instructional time or on
their own time. Additional information about ABES sampling,
data collection, response rates, and processing is available
in the overview report of this supplement (7). The ABES
questionnaire, datasets, and documentation are available at
https://www.cdc.gov/healthyyouth/data/abes.htm.

Measures
This analysis included seven measures: 1) poor mental health

during the pandemic, 2) poor mental health during the past
30 days, 3) persistent feelings of sadness or hopelessness during
the past 12 months, 4) serious consideration of attempting
suicide during the past year, 5) attempted suicide during the
past year, 6) feeling close to persons at school (time frame not
specified), and 7) being virtually connected to others during the
pandemic (Table 1). For the pandemic-related questions, the
time frame was not further specified. In addition, the following

demographic characteristics were analyzed: sex, sexual identity
(heterosexual; gay, lesbian, or bisexual; or other or questioning),
and race and ethnicity (non-Hispanic American Indian or
Alaska Native [AI/AN], non-Hispanic Asian [Asian], non-
Hispanic Black [Black], Hispanic or Latino [Hispanic], non-
Hispanic persons of multiple races [multiracial], non-Hispanic
Native Hawaiian or other Pacific Islander, and non-Hispanic
White [White]).

Analysis
Weighted prevalence estimates and 95% CIs were

calculated for all study variables among students overall
and by demographic characteristics. Statistically significant
pairwise differences for the study variables by demographic
characteristics, and for associations between mental health,
suicidality, and connectedness, were determined by t-tests
for proportions. Analyses were completed using SUDAAN
(version 11.0.3; RTI International) to account for the complex
survey design and weighting. Differences were considered
statistically significant if the p value was <0.05. Only significant
results are presented in the text.

Results

Poor Mental Health
Approximately one in three high school students experienced

poor mental health (most of the time or always) during
the COVID-19 pandemic (37.1%) and during the past
30 days (31.1%) (Table 2). During the 12 months before the

TABLE 1. Question and analytic coding for health behaviors and experiences, by variable assessed — Adolescent Behaviors and Experiences
Survey, United States, January–June 2021

Variable Question Analytic coding

Poor mental health during the pandemic During the COVID-19 pandemic, how often was your mental
health not good? (Poor mental health includes stress, anxiety,
and depression.)

Always or most of the time versus never,
rarely, or sometimes

Poor mental health during the past 30 days During the past 30 days, how often was your mental health not
good? (Poor mental health includes stress, anxiety,
and depression.)

Always or most of the time versus never,
rarely, or sometimes

Persistent feelings of sadness or
hopelessness

During the past 12 months, did you ever feel so sad or
hopeless almost every day for two weeks or more in a row
that you stopped doing some usual activities?

Yes versus no

Seriously considered attempting suicide During the past 12 months, did you ever seriously consider
attempting suicide?

Yes versus no

Attempted suicide During the past 12 months, how many times did you actually
attempt suicide?

≥1 time versus 0 times

Felt close to persons at school Do you agree or disagree that you feel close to people at
your school?

Strongly agree or agree versus not sure,
disagree, or strongly disagree

Virtually connected to others during
the

pandemic

During the COVID-19 pandemic, how often were you able to
spend time with family, friends, or other groups, such as clubs
or religious groups, by using a computer, phone, or other
device? (Do not count attending school online.)

Always, most of the time, or sometimes
versus never or rarely

https://www.cdc.gov/healthyyouth/data/abes.htm

Supplement

18 MMWR / April 1, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

survey, 44.2% experienced persistent feelings of sadness or
hopelessness; that is, had ever felt so sad or hopeless almost
every day for two weeks or more in a row that they stopped
doing some usual activities.

The prevalence of poor mental health during the pandemic,
poor mental health during the past 30 days and persistent
feelings of sadness or hopelessness were higher among female
than male students (Table 2). Although differences by race and
ethnicity were detected for each of these three variables, no
consistent patterns were found. The prevalence of poor mental
health during the pandemic was higher among gay, lesbian,
or bisexual students and other or questioning students than
among heterosexual students. The prevalence of poor mental
health during the past 30 days and of persistent feelings of
sadness or hopelessness was highest among gay, lesbian, or
bisexual students, followed by other or questioning students.
Heterosexual students had the lowest prevalence.

Suicidal Thoughts and Behaviors
During the 12 months before the survey, 19.9% of students

had seriously considered attempting suicide, and 9.0%
had attempted suicide. The prevalence of having seriously
considered attempting suicide and attempting suicide was
higher among female students than male students and varied
by race and ethnicity. The prevalence of having seriously
considered attempting suicide was higher among White
students than Black or Asian students and higher among
multiracial students than Black students. The prevalence
of having attempted suicide was higher among AI/AN
students than White, Black, Hispanic, or Asian students. The
prevalence of having seriously considered attempting suicide
and attempted suicide was highest among gay, lesbian, or
bisexual students, followed by other or questioning students.
Heterosexual students had the lowest prevalence.

TABLE 2. Percentage of students with poor mental health, persistent feelings of sadness or hopelessness, suicidal thoughts and attempts, and who
experienced connectedness,* by demographic characteristics — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

Characteristic

Poor mental
health during
the pandemic

Poor mental health
during the past

30 days

Persistent feelings of
sadness or

hopelessness
Seriously considered
attempting suicide

Attempted suicide

Felt close to
persons at school

Virtually connected
to others during the

pandemic

% (95% CI)† % (95% CI)† % (95% CI)† % (95% CI)† % (95% CI)† % (95% CI)† % (95% CI)†

Sex
Female 48.9§ (45.6–52.3) 41.6§ (38.4–44.9) 56.5§ (53.4–59.5) 26.0§ (23.4–28.6) 12.4§ (10.5–14.5) 40.8§ (36.8–44.8) 71.8 (69.7–73.8)
Male 24.4 (22.3–26.7) 19.6 (17.6–21.8) 31.4 (29.1–33.7) 13.6 (12.0–15.4) 5.3 (4.2–6.6) 53.0 (50.7–55.4) 71.7 (69.4–74.0)

Race and ethnicity
AI/AN,

non-Hispanic
23.3¶,**,†† (15.8–33.0) 20.5 (9.0–40.2) 49.5¶¶,*** (42.2–56.9) 23.3 (15.6–33.5) 20.1¶,††,¶¶,*** (12.4–30.9) 50.9*** (39.4–62.3) 70.6 (46.0–87.1)

Asian,
non-Hispanic

33.7 (27.5–40.5) 29.1 (23.7–35.1) 40.2** (34.4–46.3) 15.9†† (12.6–19.9) 7.4 (4.9–11.0) 44.3††,*** (38.2–50.6) 73.4 (67.1–78.9)

Black,
non-Hispanic

28.0¶,**,†† (23.3–33.2) 25.6¶,**,†† (22.0–29.5) 39.7¶,** (35.9–43.6) 16.2**,†† (13.0–20.0) 10.0 (7.7–12.9) 33.5¶,**,†† (29.1–38.2) 68.9†† (65.3–72.3)

Hispanic or Latino 36.8 (33.2–40.6) 31.1 (27.9–34.6) 46.4 (42.1–50.8) 19.7 (16.9–22.7) 8.4 (6.5–10.7) 41.6**,†† (37.1–46.2) 67.2†† (63.7–70.5)
Multiracial,

non-Hispanic
40.0 (32.8–47.7) 32.5 (27.0–38.5) 51.0†† (44.5–57.4) 25.6 (18.1–34.8) 12.3 (8.0–18.5) 50.8 (43.8–57.8) 68.7 (61.6–75.1)

NH/OPI,
non-Hispanic

—§§ — 45.8 (19.2–75.0) 12.4 (3.3–36.5) __ — —

White,
non-Hispanic

40.1 (37.4–42.9) 32.8 (29.6–36.2) 43.8 (40.3–47.2) 21.0 (18.6–23.6) 8.9 (7.1–11.0) 52.3 (49.5–55.1) 75.1 (73.2–76.9)

Sexual identity
Heterosexual 30.3 (27.6–33.2) 25.5 (22.5–28.8) 36.7 (34.1–39.4) 13.6 (11.7–15.8) 5.2 (4.2–6.5) 50.1 (47.1–53.1) 72.7 (70.8–74.5)
Gay, lesbian, or

bisexual
63.8††† (58.5–68.8) 54.9†††,§§§ (49.5–60.2) 75.7†††,§§§ (70.9–79.9) 46.8†††,§§§ (41.5–52.2) 26.3†††,§§§ (21.8–31.4) 36.8††† (32.2–41.6) 69.9 (65.1–74.2)

Other or
questioning

61.5††† (54.6–67.9) 45.7††† (40.5–50.9) 68.7††† (63.6–73.4) 39.5††† (34.6–44.7) 16.5††† (11.8–22.7) 33.6††† (29.1–38.4) 69.6 (65.6–73.3)

Total 37.1 (34.6–39.6) 31.1 (28.5–33.7) 44.2 (41.6–46.8) 19.9 (18.0–22.0) 9.0 (7.7–10.5) 46.6 (44.1–49.2) 71.8 (70.2–73.3)

Abbreviations: AI/AN = American Indian or Alaska Native; NH/OPI = Native Hawaiian or other Pacific Islander.
* Refer to Table 1 for variable definitions.
† All percentages are weighted.
§ Significantly different from male students, based on t-test analysis (p<0.05).
¶ Significantly different from Hispanic students, based on t-test analysis (p<0.05).
** Significantly different from non-Hispanic multiracial students, based on t-test analysis (p<0.05).
†† Significantly different from non-Hispanic White students, based on t-test analysis (p<0.05).
§§ Results suppressed because n<30.
¶¶ Significantly different from non-Hispanic Asian students, based on t-test analysis (p<0.05).
*** Significantly different from non-Hispanic Black students, based on t-test analysis (p<0.05).
††† Significantly different from heterosexual students, based on t-test analysis (p<0.05).
§§§ Significantly different from other or questioning students based on t-test analysis (p<0.05).

Supplement

MMWR / April 1, 2022 / Vol. 71 / No. 3 19US Department of Health and Human Services/Centers for Disease Control and Prevention

Connectedness
At the time of the survey, 46.6% of students strongly agreed

or agreed that they felt close to persons at school. In contrast,
71.8% of students sometimes, most of the time, or always
spent time virtually (i.e., by using a computer, telephone,
or other device) with family, friends, or others during the
pandemic. The prevalence of feeling close to persons at school
was higher among male students than female students. Being
virtually connected to others during the pandemic did not
vary by sex. The prevalence of feeling close to persons at school
and being virtually connected to others varied by race and
ethnicity. The prevalence of feeling close to persons at school
was higher among White students than Black, Hispanic, and
Asian students; higher among Hispanic, Asian, AI/AN, and
multiracial students than Black students; and higher among
multiracial students than Hispanic students. The prevalence of
being virtually connected to others was higher among White
students than Black and Hispanic students. The prevalence of
feeling close to persons at school was higher among heterosexual
students than gay, lesbian, or bisexual students and other or
questioning students; however, being virtually connected to
others during the pandemic did not vary by sexual identity.

Connectedness and Mental Health
Compared with those who did not feel close to persons

at school, students who felt close to persons at school
had a lower prevalence of poor mental health during the
pandemic (28.4% versus 45.2%) and during the past 30 days

(23.5% versus 37.8%), of persistent feelings of sadness or
hopelessness (35.4% versus 52.9%), of having seriously
considered attempting suicide (14.0% versus 25.6%), and
of having attempted suicide (5.8% versus 11.9%) (Figure).
Similarly, students who were virtually connected to others
during the pandemic had a lower prevalence of poor mental
health during the pandemic (35.5% versus 42.0%) and
during the past 30 days (28.7% versus 36.8%), of persistent
feelings of sadness or hopelessness (41.9% versus 51.7%), of
having seriously considered attempting suicide (18.4 versus
24.9%), and of having attempted suicide (8.0% versus 12.2%)
compared with those who were not virtually connected to
others during the pandemic.

Discussion
More than one in three high school students (37.1%)

experienced poor mental health during the COVID-19
pandemic. In addition, 44.2% of students experienced
persistent feelings of sadness or hopelessness, almost 20%
seriously considered suicide, and 9.0% attempted suicide
during the 12 months before the survey. The prevalence of poor
mental health and suicidality was high across students of all
sex, sexual identity, and racial and ethnic groups; however, poor
mental health, persistent feelings of sadness or hopelessness,
and suicidal thoughts and behaviors were less prevalent among
those who felt close to persons at school and were virtually
connected with others during the pandemic.

FIGURE. Persistent feelings of sadness or hopelessness, perceptions of mental health, and suicidal thoughts and attempts among high school
students during the COVID-19 pandemic, by feeling close to persons at school* and being virtually connected† — Adolescent Behaviors and
Experiences Survey, United States, January–June 2021

Attempted suicide

Students who felt close to persons at school

Strongly agree/Agree
Not sure/Disagree/Strongly disagree

Students who were virtually connected to others

Persistent feelings of
sadness or hopelessness

Poor mental health
during the pandemic

Poor mental health
during the past 30 days

Seriously considered
attempting suicide

100 0102030405060708090 0 100908070605040302010

Percentage Percentage

Always/Most of the time/Sometimes
Never/Rarely

* All comparisons of having felt close versus not sure, disagree, or strongly disagree they felt close were significantly different, based on t-test analysis (p<0.05).
† All comparisons of being connected versus never or rarely felt connected were significantly different, based on t-test analysis (p<0.05).

Supplement

20 MMWR / April 1, 2022 / Vol. 71 / No. 3 US Department of Health and Human Services/Centers for Disease Control and Prevention

During the COVID-19 pandemic, students’ feelings of
being connected to school were likely reduced by extensive
school closures and transitions to virtual learning (8). Efforts
to improve connectedness to schools, peers, and family are
critical to protecting the mental health and well-being of youths
(9), particularly in the context of ongoing pandemic-related
stressors. Evidence from previous outbreaks suggests that
the pandemic might have long-term consequences for youth
mental health and well-being and be associated with potential
increases in youth depression, anxiety, and post-traumatic stress
disorder, which underscores the urgent need to address mental
health needs among youths (10).

In addition to providing youths with access to needed mental
health care (11), comprehensive approaches that promote
help-seeking behaviors, connections to trusted adults and
supportive peers, and engagement in community activities
have been shown to have many benefits including improved
feelings of connectedness, better mental health, reduced risk
for suicide, reduced prevalence of health risk behaviors, and
better academic achievement (9,12). Positive experiences
during childhood, including school connectedness, can build
resilience and protect or buffer adults who have experienced
multiple childhood traumas (13).

To foster school connectedness and promote positive school
climates, school districts can implement schoolwide programs
such as those focused on social and emotional learning,
professional development for staff to improve classroom
management, and strategies to foster relationships between
students, their families, and school staff. Another way to foster
school connectedness and promote positive school climates is for
school districts to analyze school disciplinary policies to ensure
they are being implemented equitably across racial and ethnic
groups (9,14,15). In addition to engaging with their child’s
school, parents and caregivers can build relationships with their
child through open discussions and shared activities (15).

Limitations
General limitations to ABES are outlined in the overview

report in this supplement (7). The findings in this report are
subject to at least four specific limitations. First, the mental
health and suicidality variables used in this study are important
indicators of students’ mental well-being; however, the
questions were not designed to diagnose clinical depression.
Second, most students were virtually connected to others,
such as family, friends, or other groups, during the pandemic.
Among students who were never or rarely virtually connected,
it is unknown if that was a function of more in-person
interactions; individual choice; a lack of family, friends, or

other groups with whom students could be connected; or a
lack of access to the technology needed by the student or others
with whom the student would connect. Third, the survey did
not ask students to indicate whether, at the time of the survey
or in weeks or months preceding the survey, they attended
school in person, remotely, or both in person and remotely.
Students’ method of attendance might be a confounder for the
findings related to students’ feeling of connectedness. Finally,
because this was a one-time survey, no longitudinal data from
studies using the same data collection methods are available to
directly compare pre- and postpandemic mental health status
among youths.

Conclusion
Mental health issues among youths are an important public

health concern during the ongoing COVID-19 pandemic.
However, the findings in this report also indicate that poor
mental health, persistent feelings of sadness or hopelessness,
and suicidal thoughts and behaviors were less prevalent among
those who felt close to persons at school and were virtually
connected with others during the pandemic. Comprehensive
strategies that improve connections with others at home, in
the community, and at school might foster improved mental
health among youths during and after the pandemic.

Conflicts of Interest

All authors have completed and submitted the International
Committee of Medical Journal Editors form for disclosure of potential
conflicts of interest. No potential conflicts of interest were disclosed.

References

1. Panchal N, Kamal R, Cox C, Garfield R, Chidambaram P. Issue brief:
mental health and substance use considerations among children during
the COVID-19 pandemic. San Francisco, CA: KFF; 2021. https://www.
kff.org/coronavirus-covid-19/issue-brief/mental-health-and-substance-
use-considerations-among-children-during-the-covid-19-pandemic/

2. CDC. Youth Risk Behavior Survey: data summary and trends report
2009–2019. Atlanta, GA: US Department of Health and Human
Services, CDC; 2021. https://www.cdc.gov/healthyyouth/data/yrbs/
pdf/YRBSDataSummaryTrendsReport2019-508

3. Bitsko RH, Claussen AH, Lichstein J, et al. Mental health surveillance
among children—United States, 2013–2019. MMWR Suppl
2022;71(No. Suppl 2):1–42. PMID:35202359 https://www.cdc.gov/
mmwr/volumes/71/su/su7102a1.htm?s_cid=su7102a1_w

4. Zhang L, Zhang D, Fang J, Wan Y, Tao F, Sun Y. Assessment of mental
health of Chinese primary school students before and after school
closing and opening during the COVID-19 pandemic. JAMA Netw
Open 2020;3:e2021482. PMID:32915233 https://doi.org/10.1001/
jamanetworkopen.2020.21482

5. Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL,
Fardouly J. Risk and protective factors for prospective changes in
adolescent mental health during the COVID-19 pandemic. J Youth
Adolesc 2021;50:44–57. PMID:33108542 https://doi.org/10.1007/
s10964-020-01332-9

Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic

Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic

Mental Health and Substance Use Considerations Among Children During the COVID-19 Pandemic

https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508

https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508

https://pubmed.ncbi.nlm.nih.gov/35202359/

https://www.cdc.gov/mmwr/volumes/71/su/su7102a1.htm?s_cid=su7102a1_w

https://www.cdc.gov/mmwr/volumes/71/su/su7102a1.htm?s_cid=su7102a1_w

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=32915233&dopt=Abstract

https://doi.org/10.1001/jamanetworkopen.2020.21482

https://doi.org/10.1001/jamanetworkopen.2020.21482

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33108542&dopt=Abstract

https://doi.org/10.1007/s10964-020-01332-9

https://doi.org/10.1007/s10964-020-01332-9

Supplement

MMWR / April 1, 2022 / Vol. 71 / No. 3 21US Department of Health and Human Services/Centers for Disease Control and Prevention

6. Yard E, Radhakrishnan L, Ballesteros MF, et al. Emergency
department visits for suspected suicide attempts among persons aged
12–25 years before and during the COVID-19 pandemic—United
States, January 2019–May 2021. MMWR Morb Mortal Wkly Rep
2021;70:888–94. PMID:34138833 https://doi.org/10.15585/mmwr.
mm7024e1

7. Rico A, Brener N, Thornton J, et al. Overview and methodology of
the Adolescent Behaviors and Experiences Survey—United States,
January–June 2021. In: CDC. Adolescent Behaviors and Experiences
Survey—United States, January–June 2021. MMWR Suppl
2022;71(No. Suppl 3):1–7.

8. Hertz MF, Kilmer G, Verlenden J, et al. Adolescent mental health,
connectedness, and mode of school instruction during COVID-19.
J Adolesc Health 2022;70:57–63. PMID:34930571 https://doi.
org/10.1016/j.jadohealth.2021.10.021

9. Stone D, Holland K, Bartholow B, Crosby A, Davis S, Wilkins N.
Preventing suicide: a technical package of policy, programs, and
practices. Atlanta, GA: US Department of Health and Human
Services, CDC; 2017. https://www.cdc.gov/violenceprevention/pdf/
suicidetechnicalpackage

10. Meherali S, Punjani N, Louie-Poon S, et al. Mental health of children and
adolescents amidst COVID-19 and past pandemics: a rapid systematic
review. Int J Environ Res Public Health 2021;18:3432. PMID:33810225
https://doi.org/10.3390/ijerph18073432

11. Whitney DG, Peterson MD. US national and state-level prevalence
of mental health disorders and disparities of mental health care use in
children. JAMA Pediatr 2019;173:389–91. PMID:30742204 https://
doi.org/10.1001/jamapediatrics.2018.5399

12. Steiner RJ, Sheremenko G, Lesesne C, Dittus PJ, Sieving RE,
Ethier KA. Adolescent connectedness and adult health outcomes.
Pediatrics 2019;144:e20183766. PMID:31235609 https://doi.
org/10.1542/peds.2018-3766

13. Bethell C, Jones J, Gombojav N, Linkenbach J, Sege R. Positive
childhood experiences and adult mental and relational health in a
statewide sample: associations across adverse childhood experiences
levels. JAMA Pediatr 2019;173:e193007. PMID:31498386 https://doi.
org/10.1001/jamapediatrics.2019.3007

14. McNeely CA, Nonnemaker JM, Blum RW. Promoting school
connectedness: evidence from the National Longitudinal Study of
Adolescent Health. J Sch Health 2002;72:138–46. PMID:12029810
https://doi.org/10.1111/j.1746-1561.2002.tb06533.x

15. CDC. Adolescent connectedness. Atlanta, GA: US Department of Health
and Human Services, CDC; 2020. https://www.cdc.gov/healthyyouth/
protective/youth-connectedness-important-protective-factor-for-health-
well-being.htm

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34138833&dopt=Abstract

https://doi.org/10.15585/mmwr.mm7024e1

https://doi.org/10.15585/mmwr.mm7024e1

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=34930571&dopt=Abstract

https://doi.org/10.1016/j.jadohealth.2021.10.021

https://doi.org/10.1016/j.jadohealth.2021.10.021

https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage

https://www.cdc.gov/violenceprevention/pdf/suicidetechnicalpackage

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=33810225&dopt=Abstract

https://doi.org/10.3390/ijerph18073432

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=30742204&dopt=Abstract

https://doi.org/10.1001/jamapediatrics.2018.5399

https://doi.org/10.1001/jamapediatrics.2018.5399

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31235609&dopt=Abstract

https://doi.org/10.1542/peds.2018-3766

https://doi.org/10.1542/peds.2018-3766

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=31498386&dopt=Abstract

https://doi.org/10.1001/jamapediatrics.2019.3007

https://doi.org/10.1001/jamapediatrics.2019.3007

https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12029810&dopt=Abstract

https://doi.org/10.1111/j.1746-1561.2002.tb06533.x

https://www.cdc.gov/healthyyouth/protective/youth-connectedness-important-protective-factor-for-health-well-being.htm

https://www.cdc.gov/healthyyouth/protective/youth-connectedness-important-protective-factor-for-health-well-being.htm

https://www.cdc.gov/healthyyouth/protective/youth-connectedness-important-protective-factor-for-health-well-being.htm

International Journal of Instruction January 2022 ● Vol.15, No.1
e-ISSN: 1308-1470 ● www.e-iji.net p-ISSN: 1694-609X

pp. 457-472

Citation: Boonroungrut, C., Thamdee, N., & Saroinsong, W. P. (2022). Research on students in
COVID-19 pandemic outbreaks: A bibliometric network analysis. International Journal of Instruction,
15(1), 457-472. https://doi.org/10.29333/iji.2022.15126a

Article submission code:
20201228175236

Received: 28/12/2020
Revision: 07/07/2021

Accepted: 31/07/2021
OnlineFirst: 29/10/2021

Research on Students in COVID-19 Pandemic Outbreaks: A Bibliometric
Network Analysis

Chinun Boonroungrut
Dr., Department of Psychology and Guidance, Faculty of Education, Silpakorn
University, Thailand, boonroungrut_c@silpakorn.edu

Wulan Patria Saroinsong
Corresponding author, Dr., Department of Childhood Education, Faculty of Education,
Universitas Negri Surabaya, Indonesia, wulansaroinsong@unesa.ac.id

Natthaya Thamdee
Department of General Education, Faculty of Education, Vongchavalitkul University,
Thailand, nuttaya87@gmail.com

Over a billion students worldwide have suffered from school closure since the
beginning of COVID-19 due to confinement. Educational Researchers have been
illustrating various issues in the form of thousands of publications which signifies a
significant academic interest. This review aimed to portray the vast scientific
landscape of COVID-19 and students’ experience in the current research
directions. As many as 2,055 Scopus-indexed articles released between 2020 and
2021 (online publications) were retrieved by PRIMA guideline to be reviewed. We
performed Bibliometric network analysis using VOSviewer software to generate
the articles authors’ keywords mapping, temporal authors’ keywords mapping, and
country collaboration mapping. Researchers from the U.S., China and the U.K. led
the overall published articles. Furthermore, the researchers found nine publications
related to student mental health and medical education, which indicate a new trend.
On the other hand, Latin American and African countries are the most
unproductive in this field. This article presents a complementary educational
approach to understanding a comprehensive picture of what researchers worldwide
have been doing. Researchers suggest further future reviews of medical & nursing
education, distance learning, and social media use in times of a pandemic.

Keywords: student, COVID-19, bibliometric, network analysis, review

INTRODUCTION

The world has been facing a new disease called Coronavirus Disease 2019 (COVID-19).
COVID-19 has spread to over 200 countries, with 68 million confirmed cases and has
become a global pandemic. Over 3 billion people have been confined as a result of these

http://www.e-iji.net/

https://doi.org/10.29333/iji.2022.15126a

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circumstances. Approximately 1.5 billion students have been affected by this situation
due to school closure (Setiawan, 2020). As an effort to seek a deeper understanding of
the situation, more than 15 thousand articles have been published by researchers all over
the world exploring pathology, antiviral treatments and human experiences, including
students from all education levels, medical & nursing students, international students,
and students with disabilities (Cao et al., 2020; Pragholapati, 2020; Qiu et al., 2020;
Swift et al., 2020; Xiong et al., 2020; Aljaraideh, 2019).

There are positive and negative aspects in education during this healthcare disruption.
Fatigue among all involvement in online learning and teaching is rapidly growing. Some
educators declared the new pedagogical techniques using synchronous online tools for
not only students but also learners in various fields; however, resilience and exertions
between students and teachers have been consistently absent (Lee et al., 2021). During
the pandemic outbreak, several countries have developed a way of motivating their
students at home using online technology including MOOC as a learning platform. This
is how the pandemic reshapes the education services thru accelerating digital education
transformation. The increasing rate of MOOC users during the pandemic can represent
the rapid digital expansion in education service. It could be a key for engaging people as
an alternative method in this context with normal education and primary healthcare for
people (Kang, 2021; Pandey et al., 2021).
Students receive experiences from E-learning that schools and universities apply for
facilitating learning during the closure. While trying to adapt those changes, some
students require to be supported physically and mentally. Several evidences indicated
that students who had fixed mindset, age differences, and self-control trended to be
difficult to adjust themselves to a new learning environment. Students in the period have
more freedom to participate in learning, requiring limited and changed evaluation
(Basilaia & Kvavadze, 2020; Pokhrel & Chhetri, 2021).

Unfortunately, education systems had to continue after school closures in coping with
the infection. Students and educators felt the unexpected ripple effect of the pandemic.
Students’ undergone psychological and emotional distress in many communities around
the world becomes researchers’ interest because their findings declared some significant
differences. For example, international students showed no interest in study abroad after
the pandemic, concerning social and economic inequalities across different educational
systems (Mok et al., 2021). The economy after the pandemic had serious consequences
for many students (Van de Velde et al., 2021). Additionally, students reported more
moody, perceived stress and alcohol use than before the pandemic. Generally, white
students reported greater effect from psychological distress than other students, and
younger seemed to be less serious than older adults (Charles, 2021).

Although many researchers have reviewed COVID-19 related to several aspects of
education by adopting a common review method to collect data on specific topics from
different times and sources, a comprehensive view of all research has never been
presented. It should be noted that the number of published comprehensive reviews are
far less than the 16,000 COVID-19 related papers in all database (Yu et al., 2020).
Thus, a bibliometric analysis was applied using a quantitative statistical technique based

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International Journal of Instruction, January 2022 ● Vol.15, No.1

on the target research papers on the relevant topics via visualized network mapping
(Moed, 2012). This review method analyzes the key terms from the publication titles,
abstracts, and keywords, and predicts the trend of past-to-present studies.

The completeness of new transformative knowledge can be obtained fully from these
academic publications. Therefore, this review is appropriate to visualize the broad
landscape of COVID-19 and students from what researchers have done from 2020 to
2021. Hence, the purpose of this paper is to provide a bibliometric overview of research
clusters and directions from productive countries regarding the topics between COVID-
19 and students.

METHOD

Article Samples

The research articles in the Scopus database were target because the database is one of
the biggest abstract indexed databases (Hamidah, Sriyono & Hudha, 2020). There were
2,591 records consisted of the words ‘COVID-19’ and ‘Student’. We used the Boolean
search technique. At least one of those keywords must be explicitly stated in their titles,
abstracts or keywords. The samples were articles published between 2020 (indexed up
to December 5, 2020) and 2021 for online release and in press articles. The selected
samples were 2,055 articles which excluded 235 incorporate articles, 153 conference
papers and 121 reviews. Furthermore, the samples were articles published by 2,886
authors and co-authors and cited by 3,694 other documents. PRIMA guideline was also
adopted to identify the article samples in this study, as shown in Figure 1 (Moher,
Liberati, Tetzlaff, Altman, & Group, 2010).

Figure 1
PRISMA flow for sample identification

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International Journal of Instruction, January 2022 ● Vol.15, No.1

These samples were included in the top three journals that gained the most interest from
worldwide researchers. The most productive journals in this field were Journal of
Chemical Education (6.90% of all samples), followed by International Journal of
Environmental Research and Public Health (2.48%) and Sustainability Switzerland
(1.50%). The most cited journal was in the International Journal of Environmental
Research and Public Health (5.08% of all cited articles). In terms of citations, only the
Journal of Chemical Education did not appear as the top ten-ranked journal. The authors
and co-authors from the United States (U.S.) (28.41%), China (8.02%), and United
Kingdom (6.76%) were the world’s top three contributors. Furthermore, Harvard
Medical School (U.S.), Saveetha Institute of Medical and Technical Sciences (India),
University of Pennsylvania (U.S.), and Saveetha Dental College and Hospital (India)
were the world-leading affiliation. However, the most cited published research was from
the University of Toronto (Canada).

Data Analysis

The bibliographic network analysis was used to create a map of co-occurrences
exploring the authors’ research keywords. In terms of the network calculations, the
authors’ keywords were visualized without the key term ‘COVID-19’ and its related
terms. This omission might provide a clearer cluster among explored authors’ keywords.
The mapping nodes and their relations were represented using different color spots and
lines to link them as clusters. The size of a circle was calculated based on co-
occurrences which referred to the searched articles and terms. First, a cluster network
mapping was visualized together with temporal overlay visualization, which presented
updated authors’ key terms in this study—the colors of circles referred to each cluster
and their membership. Second, a country and co-country mapping were created by the
calculated number of documents, demonstrating how researchers collaborated with
different institutions in different countries.

Notably, the ease of interpretation, which showed highly frequent units, could affect the
bibliometric mapping’s visualized layout. In the preliminary testing, various occurrence
threshold selections were conducted to present the primary research trends’ full
visibility. Inconsistent mappings were discarded to avoid any possible arbitrariness.
Fractional weight and Lin-Log modularity were applied to set each units’ normalization.
The map of authors’ keywords was calculated from a minimum of 3 occurrences per
term presenting 128 thresholds from 1,189 keywords. A co-country mapping included
117 countries that published more than 3 papers presenting 56 thresholds. The samples
were analyzed by VOSviewer (version 1.16.13 on Mac OS) (Perianes-Rodriguez,
Waltman, & Van Eck, 2016).

FINDINGS

The authors’ keywords co-occurrence mapping has visualized nine recognized clusters,
as presented in Figure 2 and Table 1. The yellow cluster at the top left mostly includes
the nodes on remote learning and emergency remote teaching, as well as medical and
nursing students and quarantine. It was a trivial cluster compared to other clusters. The
light blue cluster at the top center were nodes related to higher education and terms

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International Journal of Instruction, January 2022 ● Vol.15, No.1

related to online behavior, Google Classroom and mobile application learning. The
brown cluster next to the light blue cluster seemed to be related to terms from online
learning approaches, including online learning and e-learning, and social distancing,
such as health science and health crisis. The orange cluster next to the brown cluster
included significant nodes related to distance learning and terms related to video
conferencing tools, learning habits and social media. The red color cluster at the top
consists of a significant node related to the curriculum as the betweenness-centric and
terms related to self-instruction among various learners, such as upper-division
undergraduate, second-year undergraduate graduate students. Besides, this cluster
included several learning styles as tiny nodes such as collaborative learning, internet and
web-based learning and multimedia-based learning.

This mapping presented the well-recognized cluster named the dark blue cluster. This
cluster primarily includes the nodes on medical education and medical students’ terms
with measuring telehealth and social isolation variables. The most significant cluster in
this mapping was the violet cluster at the bottom center position. This cluster contains
nodes related to psychological factors, such as mental health, stress, depression and
anxiety. Considerably, this cluster was closer to each other, which might represent how
researchers gathered terms and used closely related approaches. The green cluster
represents terms related to knowledge and perceptions, including attitudes and
awareness among university students and dental students. The pink cluster was the
narrowest cluster which contained the nodes about psychological factors on lockdown
period including coping strategies, PTSD, well-being, social support and resilience. The
light green cluster located at the bottom right includes terms related to international
students in China and Australia. The last cluster, an old rose color located at the right
side of the green color, contains the terms related to medical education and training
linked with active learning and telemedicine.

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Figure 2
Authors’ keywords co-occurrence Mapping

Table 1
Top 20 keywords’ link strength
No Keywords Occurrences Link

Strength
No Keywords Occurrences Link

Strength
1 Anxiety 47 167 11 Curriculum 9 38
2 Mental Health 45 146 12 Lockdown 12 38
3 Depression 31 124 13 Higher education 13 35
4 Stress 24 93 14 Dental student 9 25
5 Knowledge 23 78 15 Perception 7 24
6 Medical students 30 67 16 Physical activity 7 23
7 Online learning 30 63 17 China 9 22
8 Distance learning 19 62 18 Coping 5 22
9 Medical education 28 56 19 Quarantine 7 22
10 Attitude 12 43 20 Fear 6 21

As presented in Figure 3, the latest terms were principally presented in the violet orange
clusters and a small portion in the dark blue cluster compared to Figure 1. Emergency
remote teaching is the newest term from the yellow cluster. The favored term of the
brown cluster is distance learning. Another cluster consists of the latest terms, such as
physical activity, exercise, and sleep, related to medical education. Topics on Mental
health greatly interest worldwide researchers as the latest in the violet cluster. Lastly,
research interest in students in China has been concluded as a current trend.

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International Journal of Instruction, January 2022 ● Vol.15, No.1

Figure 3
Authors’ keywords co-occurrence Temporal Mapping
Note: Lighter color refers to update terms

A global overview of the leading countries mapping was contributed to academic
publications related to student and COVID-19 within the pandemic outbreak, presented
in Figure 4 and Table 2. The mapping presented 7 visualized clusters of various
countries, including 5 major and 2 minor clusters. Counting without weighting
population in any 117 countries in this study, researchers from the U.S., Spain, and
Singapore, Italy and Vietnam, a red cluster, were clearly leading. Researchers from
China had published more relevant articles with other East and South Asian countries,
including India, Hong Kong and Thailand, a yellow cluster). As presented in the green
cluster, Middle East countries, including Saudi Arabia, United Arab Emirates, and other
South and Southeast Asian countries, Bangladesh, Pakistan, Malaysia, and Indonesia,
tend to collaborate closely with one another. United Kingdom researchers, an orange
cluster, worked closely with U.S. researchers. Remarkably, although the outbreak in
Europe, Latin and African countries seemed to be serious, the overall productivity rates
in this field were very low.

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Table 2
Most productive counties
No Countries Ndoc %Ndoc NCitation %NCitation Link Strength
North America
1 United States 175 16.55 562 29.30 40
2 Canada 22 2.08 34 1.77 21
Asia & Oceania
1 China 73 7.37 509 26.53 20
2 Pakistan 16 1.51 52 2.71 19
3 Saudi Arabia 28 2.64 14 .72 15
4 Australia 30 2.83 30 1.56 12
5 Malaysia 19 1.79 48 2.50 11
Europe
1 United Kingdom 85 8.04 106 5.52 40
2 Italy 13 1.22 23 1.19 11
3 Denmark 5 .47 31 1.61 10
4 Netherlands 7 .66 3 .15 10
5 France 11 1.04 8 .41 8
Latin America
1 Peru 7 .66 2 .10 5
2 Brazil 13 1.22 9 .46 1
3 Columbia 7 .66 2 .10 1
4 Mexico 5 .47 2 .10 0

Note: The database recruited only 2 counties in North America and 4 countries in Latin.

Figure 4
Co-country authorship

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DISCUSSION

This review employed the bibliometric network analysis to overview researchers’
studies worldwide on students during the COVID-19 pandemic. The samples were 2,055
Scopus-indexed articles. These samples were published by 2,886 authors and co-
authors. It might be evidence of disseminating knowledge among researchers within this
field. According to the main review findings, the following are the discussion sections
that highlight several topics that could be reviewed in the future.

COVID-19 and Students’ Mental Health

It was found that mental health was visualized as the most significant cluster, as
presented in Figure 2 and 3. It signifies that most researchers showed interest in this
issue, especially regarding depression and anxiety. Considerably, students were reported
to present more psychiatric forms in this outbreak (Lei et al., 2020; Mazza et al., 2020;
Wang et al., 2020). In a review of Xiong et al. (2020), students are at risk of developing
more depressive symptoms than active and retired employees. Female students were
higher than males. Moreover, Cao et al. (2020) and Qiu et al. (2020) indicated that when
school closures happen, class cancellation examination postponements and remoting
online courses, students tend to be more vulnerable to increasing emotional distress and
PTSD symptoms.

Considering the influence of family protection factors, parental marital satisfaction, and
intimacy trended to receive social support higher than family, which worsens parents’
conflicts. In addition, families with university or college students exhibited fewer signs
of depression and anxiety than other students’ stages. The low economic class was more
affected, with higher stress, depression and anxiety among parents who have sons or
daughters in any learning stages (Husky, Kovess-Masfety, & Swendsen, 2020; Patrick et
al., 2020; Tang, Xiang, Cheung, & Xiang, 2020; Wu et al., 2020). There were few
subclinical misbehavior publications, such as eating and dietary restriction among
students in lockdown period. It was confirmed that the higher the stress, the higher the
risk of problematic eating behaviors, including eating habits and lifestyle changes
(Bajramovic et al., 2020; Duong et al., 2020; Flaudias et al., 2020). Notably, student
suicide cases related to learning issues were reported in some Asian counties
(Lathabhavan & Griffiths, 2020; Mamun, Chandrima, & Griffiths, 2020; Ueda,
Nordström, & Matsubayashi, 2020; Utomo, Hasanah, Hariyadi & Narulita, 2020).

This is an opportunity for school administrators to leverage mental care and resilience
promoting factors to support students, including international students and dormitories,
when returning to school are eventually suggested by almost researchers. The
requirement to develop intervention or any service strategies to detect underlying mental
health of student is imminent and professional support warrant a more effective
approach to any possible future health disruption (King, Cabarkapa, Leow, & Ng, 2020;
Liu, Pinder-Amaker, Hahm, & Chen, 2020; Son, Hegde, Smith, Wang, & Sasangohar,
2020).

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COVID-19 and Medical Student Education

Medical student education in the outbreak gained tremendous interest. The advancement
of telehealth and other protocols was flexibly approached and evaluated as a solution
(Rose, 2020). Medical researches and innovative solutions were turning to face this
public health problem in a huge variety of ways (Kinder & Harvey, 2020; Miller,
Pierson, & Doernberg, 2020). Medical students volunteering as interprofessional
practices, including health services and K-12 healthcare education engaging were
reported in many settings as problem-based learning. The public projects might not
occur when they did not hold typical opportunities (Buckland, 2020; Reardon et al.,
2020). There was a significant effect on students’ confidence and preparedness that
assisting in some healthcare area during the outbreak could be a valuable learning
experience (Choi et al., 2020). Medical education receives the advantage of e-learning
in both students and teachers to develop new teaching strategies. Combining into useful
blend learning modes can be successfully migrated to various medical education fields,
including radiology, neurosurgery and oncology (Chae et al., 2020; Darras et al., 2020;
Pollom et al., 2020).

COVID-19 and Latino and African research

According to the global overview mapping, Latin and African countries were
insufficient in the sample to analyze. It referred to a small number of published
publications and no systematic review, by researchers in those regions. One research
was declared the interconnected dimensions, which indicated low social-economic
students suffered from these consequent outcomes. Only one-third of students can access
qualified online learning platforms. Several teachers faced issues with integrating digital
devices into the curricula. It was found that almost half of the students could assess the
internet connection at home. In addition, lack of parental support significantly affected
students when they stayed at home because of their school closures (Alexander,
Entwisle, & Olson, 2001; Basto-Aguirre, Cerutti, & Nieto-Parra, 2020). For the better
discussion, some local indexed publications indicated that students in those Latin
countries might face psychological distress the same as other areas in the world that
might be further reviewed by local researchers. Students in these countries changed their
dietary habits in this COVID-19 confinement by increasing food intake (Ruiz-Roso et
al., 2020), and declared higher suicide risk (Caballero-Domínguez, Jiménez- Villamizar,
& Campo-Arias, 2020). Some researches among African students defined higher
depression in female student (Rakhmanov & Dane, 2020). There was a requirement for
adequate communication infrastructure in higher education to connect students with
their institutions during the closure (Marinoni, Van’t Land, & Jensen, 2020).

In many studies, researchers explore the advantages of supporting applications that
communicate with students, students and parents. Social media was adopted together
with those learning applications and platforms. Interest in the massive open online
course (MOOC) reach the highest rate in many countries. Students’ ICT-based skills
were developed in this lockdown period. Many countries provide psychological
assistance to avoid the feeling of isolation. During this confinement, educational

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International Journal of Instruction, January 2022 ● Vol.15, No.1

policymakers should consider students’ mental health and support to their families and
teachers (Boonroungrut & Saroinsong, 2020; Chang & Yano, 2020; Saroinsong, Reza,
Khotimuh, & Boonroungrut, 2020).

LIMITATIONS AND CONCLUSIONS

More academic articles have been published during the pandemic. The sample articles in
this study were particularly big enough to review that could help researchers obtain
valuable information for understanding COVID-19 influences on students using the
bibliometric network. Several considerations should be noted before implementing these
findings. The samples were taken from only the Scopus database; thus, a review from
other research databases can be made in the future. Additionally, this study only
included articles published in English. Exploring articles in other languages might be an
option for local researchers.

In conclusion, nine visualized clusters of research related to COVID-19 and students
were found by co-occurrence in the Scopus database. Publications on mental health and
psychological factors gained the most interest from worldwide researchers followed by
medical education and online learning & distance learning. The temporal mapping
indicated distance learning, mental health and several times related to physical activities
as updated research terms. Geographical mapping revealed that researchers from the
U.S., China and the U.K. were the world-leading authors in terms of quantity. There was
a limited number of publications from Latin and African countries in this database.
Finally, we recommend that researchers research medical and nursing education,
distance learning, or social media use during a pandemic in the future.

DISCLOSURE STATEMENT

No conflict of interest was reported by the authors.

REFERENCES

Alexander, K. L., Entwisle, D. R., & Olson, L. S. (2001). Schools, achievement, and
inequality: A Seasonal Perspective. Educational Evaluation and Policy Analysis, 23(2),
171-191. doi.org/10.3102/01623737023002171

Aljaraideh, Y. (2019). Massive Open Online Learning (MOOC) Benefits and
Challenges: A Case Study in Jordanian Context. International Journal of
Instruction, 12(4), 65-78. doi.org/10.29333/iji.2019.1245a

Bajramovic, I., Redzepagic, S., Bjelica, D., Krivokapic, D., Jeleskovic, E., & Likic, S.
(2020). Level of Active Lifestyle and Exercise Approach among Sports-Active Female
Students of The University of Sarajevo during the Covid-19 Pandemic. Journal of
Anthropology of Sport and Physical Education, 4(4), 33-36.
doi.org/10.26773/jaspe.201006

Basilaia, G., & Kvavadze, D. (2020). Transition to online education in schools during a
SARS-CoV-2 coronavirus (COVID-19) pandemic in Georgia. Pedagogical
Research, 5(4), 133-140. doi.org/10.29333/pr/7937

468 Research on Students in COVID-19 Pandemic Outbreaks: A …

International Journal of Instruction, January 2022 ● Vol.15, No.1

Basto-Aguirre, N., Cerutti, P., & Nieto-Parra, S. (2020). COVID-19 can widen
educational gaps in Latin America: some lessons for urgent policy action. Retrieved
fromhttp://www.lacea.org/vox/?q=blog/covid19_ widen_educational_gaps

Boonroungrut, C., & Saroinsong, W. P. (2020). Analysis of Public Interest in MOOCs
Using Google Trends®: An Evidence from Thai Domestic and International MOOC
Providers. (Unpublished Work).

Buckland, R. (2020). Medical student volunteering during COVID-19: lessons for future
interprofessional practice. Journal of Interprofessional Care, 34(5), 679-681.

Caballero-Domínguez, C. C., Jiménez-Villamizar, M. P., & Campo-Arias, A. (2020).
Suicide risk during the lockdown due to coronavirus disease (COVID-19) in Colombia.
Death studies, 1-6.

Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The
psychological impact of the COVID-19 epidemic on college students in China.
Psychiatry research. 287, 1-5. doi.org/10.1016/j.psychres.2020.112934

Chae, J. K., Haghdel, A., Guadix, S. W., Winston, G. M., Younus, I., Radwanski, R., . .
. Pannullo, S. C. (2020). COVID-19 impact on the medical student path to neurosurgery.
Neurosurgery, 87(2). 232–233, doi.org/10.1093/neuros/ nyaa187

Chang, G.-C., & Yano, S. (2020). How are countries addressing the Covid-19
challenges in education? A snapshot of policy measures. Retrieved from
https://gemreportunesco.wordpress.com/2020/03/24/how-are-countries-addressing-the-
covid-19-challenges-in-education-a-snapshot-of-policy-measures/

Charles, N. E., Strong, S. J., Burns, L. C., Bullerjahn, M. R., & Serafine, K. M. (2021).
Increased mood disorder symptoms, perceived stress, and alcohol use among college
students during the COVID-19 pandemic. Psychiatry research, 296, 1-11.

Choi, B., Jegatheeswaran, L., Minocha, A., Alhilani, M., Nakhoul, M., & Mutengesa, E.
(2020). The impact of the COVID-19 pandemic on final year medical students in the
United Kingdom: a national survey. BMC medical education, 20(1), 1-11.
doi.org/10.1186/s12909-020-02117-1

Darras, K. E., Spouge, R. J., de Bruin, A. B., Sedlic, A., Hague, C., & Forster, B. B.
(2020). Undergraduate radiology education during the COVID-19 pandemic: a review
of teaching and learning strategies. Canadian Association of Radiologists Journal,
doi.org/10.1177/0846537120944821

Duong, T. V., Pham, K. M., Do, B. N., Kim, G. B., Dam, H. T., Le, V.-T. T., . . . Le, T.
T. (2020). Digital Healthy Diet Literacy and Self-Perceived Eating Behavior Change
during COVID-19 Pandemic among Undergraduate Nursing and Medical Students: A
Rapid Online Survey. International Journal of Environmental Research and Public
Health, 17(19), 256-277 doi: 10.3390/ijerph17197185

Flaudias, V., Iceta, S., Zerhouni, O., Rodgers, R. F., Billieux, J., Llorca, P.-M., . . .
Maurage, P. (2020). COVID-19 pandemic lockdown and problematic eating behaviors

Boonroungrut, Thamdee & Saroinsong 469

International Journal of Instruction, January 2022 ● Vol.15, No.1

in a student population. Journal of Behavioral Addictions, 9(3), 826-835.
doi.org/10.1556/2006.2020.00053

Hamidah, I., Sriyono, S., & Hudha, M. N. (2020). A Bibliometric analysis of Covid-19
research using VOSviewer. Indonesian Journal of Science and Technology, 5(2), 209-
216. doi.org/10.17509/ijost.v5i2.24522

Husky, M. M., Kovess-Masfety, V., & Swendsen, J. D. (2020). Stress and anxiety
among university students in France during Covid-19 mandatory confinement.
Comprehensive Psychiatry, 102, 1-3. doi.org/10.1016/j.comppsych. 2020.152191

Kang, B. (2021). How the COVID-19 pandemic is reshaping the education service. The
Future of Service Post-COVID-19 Pandemic, 1, 15-36.

Kinder, F., & Harvey, A. (2020). Covid-19: the medical students responding to the
pandemic. BMJ Student, 369, 1-2 doi.org/10.1136/bmj.m2160

King, J. A., Cabarkapa, S., Leow, F. H., & Ng, C. H. (2020). Addressing international
student mental health during COVID-19: an imperative overdue. Australas Psychiatry,
28(4), 469-469. doi.org/10.1177/1039856220926934

Lee, K., Fanguy, M., Lu, X. S., & Bligh, B. (2021). Student learning during COVID-19:
It was not as bad as we feared. Distance Education, 42(1), 164-172.

Lathabhavan, R., & Griffiths, M. (2020). First case of student suicide in India due to the
COVID-19 education crisis: a brief report and preventive measures. Asian journal of
psychiatry, 53. 1-3. doi.org/10.1016/j.ajp.2020.102202

Lei, L., Huang, X., Zhang, S., Yang, J., Yang, L., & Xu, M. (2020). Comparison of
prevalence and associated factors of anxiety and depression among people affected by
versus people unaffected by quarantine during the COVID-19 epidemic in southwestern
China. Medical Science Monitor: International Medical Journal of Experimental and
Clinical Research, 26, 1-12. doi.org/10.12659/MSM.924609

Liu, C. H., Pinder-Amaker, S., Hahm, H. C., & Chen, J. A. (2020). Priorities for
addressing the impact of the COVID-19 pandemic on college student mental health.
Journal of American College Health, 1-3. doi.org/10.1080/ 07448481.2020.1803882

Mamun, M. A., Chandrima, R. M., & Griffiths, M. D. (2020). Mother and son suicide
pact due to COVID-19-related online learning issues in Bangladesh: An unusual case
report. International Journal of Mental Health and Addiction, 1-4.
doi.org/10.1007/s11469-020-00362-5

Marinoni, G., Van’t Land, H., & Jensen, T. (2020). The impact of Covid-19 on higher
education around the world. IAU Global Survey Report. Paris: France.

Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., & Roma, P.
(2020). A nationwide survey of psychological distress among italian people during the
COVID-19 pandemic: Immediate psychological responses and associated factors.

470 Research on Students in COVID-19 Pandemic Outbreaks: A …

International Journal of Instruction, January 2022 ● Vol.15, No.1

International Journal of Environmental Research and Public Health, 17(9), 1-14.
doi.org/10.3390/ijerph17093165

Miller, D. G., Pierson, L., & Doernberg, S. (2020). The role of medical students during
the COVID-19 pandemic. In: American College of Physicians. Retrieved from
https://www.acpjournals.org/doi/full/10.7326/M20-1281?url_ver=Z39.88-
2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed

Moed, H. (2012). The use of big datasets in bibliometric research. Research Trends, 30,
31-33. doi.org/10.7326/M20-1281

Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2010). Preferred
reporting items for systematic reviews and meta-analyses: the PRISMA statement.
International journal of surgery, 8(5), 336-341. doi.org/ 10.1016/j.ijsu.2010.02.007

Mok, K. H., Xiong, W., Ke, G., & Cheung, J. O. W. (2021). Impact of COVID-19
pandemic on international higher education and student mobility: Student perspectives
from mainland China and Hong Kong. International Journal of Educational
Research, 105, 1-11.

Pandey, D., Ogunmola, G. A., Enbeyle, W., Abdullahi, M., Pandey, B. K., & Pramanik,
S. (2021). COVID-19: A framework for effective delivering of online classes during
lockdown. Human Arenas, 1, 1-15.

Patrick, S. W., Henkhaus, L. E., Zickafoose, J. S., Lovell, K., Halvorson, A., Loch, S., .
. . Davis, M. M. (2020). Well-being of parents and children during the COVID-19
pandemic: a national survey. Pediatrics, 146(4) 202-227. doi.org/10.1542/peds.2020-
0836

Perianes-Rodriguez, A., Waltman, L., & Van Eck, N. J. (2016). Constructing
bibliometric networks: A comparison between full and fractional counting. Journal of
Informetrics, 10(4), 1178-1195. doi.org/10.1016/j.joi.2016.10.006

Pokhrel, S., & Chhetri, R. (2021). A Literature Review on Impact of COVID-19
Pandemic on Teaching and Learning. Higher Education for the Future, 8(1), 133-141.

Pollom, E. L., Sandhu, N., Frank, J., Miller, J. A., Obeid, J.-P., Kastelowitz, N., . . .
Donaldson, S. S. (2020). Continuing medical student education during the coronavirus
disease 2019 (COVID-19) pandemic: Development of a virtual radiation oncology
clerkship. Advances in radiation oncology, 5(4), 732-736.
doi.org/10.1016/j.adro.2020.05.006

Pragholapati, A. (2020). COVID-19 IMPACT ON STUDENTS. Department of Nursing,
Faculty of Sport Education and Health, Universitas Pendidikan Indonesia. Retrieved
from https://edarxiv.org/895ed/

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of
psychological distress among Chinese people in the COVID-19 epidemic: implications
and policy recommendations. General psychiatry, 33(2), 1-3. doi.org/10.1136/gpsych-
2020-100213

Boonroungrut, Thamdee & Saroinsong 471

International Journal of Instruction, January 2022 ● Vol.15, No.1

Rakhmanov, O., & Dane, S. (2020). Knowledge and anxiety levels of African university
students against COVID-19 during the pandemic outbreak by an online survey. J Res
Med Dental Sci, 8(3), 53-56.

Reardon, R., Beyer, L., Carpenter, K., Irwin, M., Kester, K., Laird, J., . . . Conrad, R.
(2020). Medical Student Development of K-12 Educational Resources During the
COVID-19 Pandemic. Academic Pediatrics, 20(6), 763–764. doi.org/
10.1016/j.acap.2020.05.022

Rose, S. (2020). Medical student education in the time of COVID-19. JAMA Network,
323(21), 2131-2132. doi.org/ 10.1001/jama.2020.5227

Ruiz-Roso, M. B., de Carvalho Padilha, P., Mantilla-Escalante, D. C., Ulloa, N., Brun,
P., Acevedo-Correa, D., . . . de Oliveira Cardoso, L. (2020). Covid-19 confinement and
changes of adolescent’s dietary trends in Italy, Spain, Chile, Colombia and Brazil.
Nutrients, 12(6), 1807-1821. doi.org/10.3390/nu12061807

Saroinsong, W., Reza, M., Khotimuh, N., & Boonroungrut, C. (2020). A Stress
Immunity System of Covid-19 Through Academic Stress. Paper presented at the The
International Joint Conference on Arts and Humanities (IJCAH 2020), Surabaya,
Indonesia.

Setiawan, A. R. (2020). Scientific Literacy Worksheets for Distance Learning in the
Topic of Coronavirus 2019 (COVID-19). (Unpublish Work). doi.org/
10.35542/osf.io/swjmk

Son, C., Hegde, S., Smith, A., Wang, X., & Sasangohar, F. (2020). Effects of COVID-
19 on college students’ mental health in the United States: Interview survey study.
Journal of medical internet research, 22(9), 1-14. doi.org/ 10.2196/21279

Swift, A., Banks, L., Baleswaran, A., Cooke, N., Little, C., McGrath, L., . . . Williams,
G. (2020). COVID‐19 and student nurses: A view from England. Journal of clinical
nursing, 29, 17-18. doi: 10.1111/jocn.15298

Tang, S., Xiang, M., Cheung, T., & Xiang, Y.-T. (2020). Mental health and its
correlates among children and adolescents during COVID-19 school closure: The
importance of parent-child discussion. Journal of Affective Disorders, 279. 353-360.
https://doi.org/10.1016/j.jad.2020.10.016

Ueda, M., Nordström, R., & Matsubayashi, T. (2020). Suicide and mental health during
the COVID-19 pandemic in Japan. medRxiv. doi.org/10.1101/2020.10.06 .20207530

Utomo, A. P., Hasanah, L., Hariyadi, S., & Narulita, E. (2020). The Effectiveness of
STEAM-Based Biotechnology Module Equipped with Flash Animation for Biology
Learning in High School. International Journal of Instruction, 13(2), 463-476.
doi.org/10.29333/iji.2020.13232a

Van de Velde, S., Buffel, V., Bracke, P., Van Hal, G., Somogyi, N. M., Willems, B.
(2021). The COVID-19 International Student Well-being Study. Scandinavian Journal
of Public Health, 49(1), 114-122.

472 Research on Students in COVID-19 Pandemic Outbreaks: A …

International Journal of Instruction, January 2022 ● Vol.15, No.1

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., McIntyre, R. S., . . . Sharma, V. K. (2020).
A longitudinal study on the mental health of general population during the COVID-19
epidemic in China. Brain, Behavior, and Immunity, 87. 40-48. doi.org/
10.1016/j.bbi.2020.04.028

Wu, M., Xu, W., Yao, Y., Zhang, L., Guo, L., Fan, J., & Chen, J. (2020). Mental health
status of students’ parents during COVID-19 pandemic and its influence factors.
General psychiatry, 33(4), 1-9. doi.org/10.1136/gpsych-2020-100250

Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M., Gill, H., Phan, L., . . . Majeed, A. (2020).
Impact of COVID-19 pandemic on mental health in the general population: A systematic
review. Journal of affective disorders, 277. 55-64. doi.org/ 10.1016/j.jad.2020.08.001

Yu, Y., Li, Y., Zhang, Z., Gu, Z., Zhong, H., Zha, Q., & Yang, L. (2020). A bibliometric
analysis using VOSviewer of publications on COVID-19. Annals of Translational
Medicine, 8(13), 1-11. doi.org/10.21037/atm-20-4235

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