Investigating Mental Health of US College Students During the COVID-19 PandemicCross-Sectional Survey Study

Xiaomei Wang, Sudeep Hegde, Changwon Son, Bruce Keller, Alec Smith, Farzan Sasangohar•View original

OverviewBalancedalloy voice

Picture the spring of 2020. Cases were climbing, dorms were emptying, and laptops were propped on kitchen tables. At Texas A&M, campuses shut down on March 23, and a statewide stay-at-home order landed a week later, on April 2. That abrupt pivot didn't just shuffle classes online. It disrupted routines, scattered support networks, and turned the most social years of life into an isolation experiment. Students were already walking a mental health tightrope. A year before the pandemic, the Center for Collegiate Mental Health's annual report flagged anxiety as the most common problem among counseling center clients, with sixty-two point seven percent out of more than eighty thousand students. So, when COVID hit, the question wasn't if stress would rise on campus. It was how high, for whom, and what might help. Wang and colleagues at Texas A&M set out to take that snapshot at the exact moment the ground gave way. They ran an online survey in the late spring of 2020, from May 4 through May 19, right in the first surge. Invitations went to the entire College Station student body, which was more than sixty thousand people, and two thousand thirty-one responded. The study did two things at once. It measured depression and anxiety with standardized tools—the Patient Health Questionnaire-9 for depressive symptoms and the Generalized Anxiety Disorder-7 for anxiety—and it listened. It asked students to name the stressors they faced, the coping strategies they actually used, and the barriers that kept them from care. Then it tied those pieces together, statistically and thematically, to show the lived picture of mental health on a big U.S. campus when the pandemic doors slammed shut. Here's the headline. Almost half of surveyed students fell into the moderate-to-severe range for depression, with forty-eight point fourteen percent. More than a third were in that same range for anxiety, at thirty-eight point forty-eight percent. Nearly one in five, or eighteen point four percent, reported suicidal thoughts in just the two weeks before they answered the survey. When asked directly about how their stress changed, seven in ten said it went up during the pandemic. Only five percent said it went down. When pressed on whether they felt able to cope, forty-three point twenty-five percent said yes, fifteen point eighty-four percent said no, and the rest weren't sure. That uncertainty is its own kind of alarm bell. If you pull back from the strict "moderate-to-severe" cutoff and look at any symptoms at all, the scope grows. Of one thousand nine hundred ninety-four complete Patient Health Questionnaire-9 responses, eighty point fifty-seven percent scored five or higher, which means some level of depression. Most were in the mild to moderate bands—about a third mild, a quarter moderate—but a substantial block landed in the heavier tiers, with fifteen point eighty-five percent moderately severe and seven point forty-two percent severe. Anxiety followed a similar arc. Out of two thousand fourteen complete Generalized Anxiety Disorder-7 responses, seventy-one point seventy-five percent reported at least mild anxiety, with roughly a third mild, about a quarter moderate, and fourteen point eighty percent severe. And those suicidal thoughts? Three hundred sixty-six students said yes; most reported that the thought occurred "several days," some said "more than half the days," and a smaller group said "nearly every day." Not everyone was hit equally. When Wang's team compared groups, two patterns stood out. Gender mattered, and place in the academic ladder mattered. Using a two-way analysis of variance—think of it as checking how two factors, like gender and student classification, each nudge average scores—they found significant effects across the board. Women reported higher symptoms, by one point seventy-six on the Patient Health Questionnaire-9 and two point twenty-two on the Generalized Anxiety Disorder-7. Effect sizes were modest but real. Students further along in their programs tended to score lower than those earlier on. Doctoral students, for example, had significantly lower depression and anxiety scores than undergraduates; even among undergraduates, seniors fared better than freshmen on depression. Master's students often fell in between, with a notable difference from sophomores on anxiety. The pattern doesn't say who is "resilient" and who isn't. It indicates that context—where you are in your training, how much structure you have, and how much uncertainty you face—showed up in these numbers. What was weighing on students day to day? When you read the open responses, a rank order emerges. Among the one thousand three hundred sixty students who explained why their stress rose, academics topped the list—thirty-nine point twelve percent pointed there first. The reasons were concrete: an abrupt shift to online classes that didn't feel like a simple swap, worries about grades, and fear that graduation might slip. Right behind, an almost identical share named the fog of pandemic uncertainty itself at thirty-four point seventy-eight percent, and health concerns at thirty-four point seventy-one percent—not just fear of catching COVID, but worry about the mental health toll and the safety of parents and grandparents. Money troubles entered for about one in five, and changes to living and work environments—working from home, cabin fever, and moving back in with family—also sat in that same neighborhood at just over twenty percent. Social life took a hit for many, with eighteen point fifty-three percent naming isolation or lost community as a main stressor. A handful even reported less stress, usually because commutes vanished and schedules loosened. For them, time was a pressure valve. Academic strain wasn't just about vibes; it showed up in the checkboxes, too. Nine out of ten students, or ninety point seventy-four percent, reported trouble concentrating. Almost as many worried about academic progress and future plans, at eighty-nine point fifty-seven percent. Three out of four students, or seventy-six point zero three percent, said adapting to distance learning was a challenge. That's a lot of cognitive load piled on top of a moving target. Health and daily rhythms were bending, too. Nearly nine in ten, or eighty-nine point twenty-four percent, expressed concern about their own health or that of loved ones. Sleep changed for the vast majority, with eighty-four point ninety-two percent saying so, and eating patterns shifted for eighty point forty-four percent. Two-thirds reported depressive thoughts. Those are the kinds of changes that don't just reflect stress—they amplify it. Sleep, diet, mood: they're the scaffolding. When they wobble, everything feels shakier. So, what did students actually do to cope? The first line wasn't an app or a campus service. It was people. Sixty-seven percent leaned on support from family, friends, or their broader communities. Technology played a supporting role—about a third used websites, mobile apps, or even sensors to manage stress—but uptake of university services was much lower. Roughly one in ten used campus counseling, and fewer tapped campus health services for mental health. Notably, one in five said they used no coping mechanism at all. Among those who did describe specific tactics, exercise topped the list, alongside meditation, reading, music, creative outlets, and spiritual practices. A subset mentioned what we'd call negative coping—distraction, isolation, alcohol, even self-harm—signaling needs that weren't being met elsewhere. A quick tour through the technology side reveals a niche but telling pattern. About fourteen point twenty-eight percent used mobile apps specifically for stress management, and among the nearly three hundred who named names, mindfulness dominated. Roughly seventy-two percent of those app users chose meditation or breathing apps—think Headspace, guided relaxation, and simple timers that teach you to pause. That doesn't tell us the apps worked. It tells us which tools felt approachable in the crush of change. Where were students getting their pandemic information? From the institutions closest to them. University emails were the most common source, at sixty-one point eighty-nine percent, followed closely by newspapers and periodicals at sixty point twelve percent. Social media fed half the sample. Medical websites and providers trailed behind, which makes sense when speed beats nuance and inboxes win the attention race. Now, the other side of the ledger: when students wanted help, what got in the way? Money, stigma, and simple lack of knowledge. Financial barriers—fees and insurance—were cited by seventy point sixty-one percent of respondents. Social stigma came next at fifty-eight point seventy-nine percent, then lack of information about available resources at fifty-four point eleven percent, and limited access to services at forty-eight point fifteen percent. In the open comments, some students named self-imposed barriers—hesitation, doubts about whether treatment would help, discomfort talking about mental health, or worries about quality. None of these are abstract problems. They're the potholes you hit on the way to care, especially when the road itself is new. So, how does this campus snapshot fit into the broader scientific picture? It's high. Wang's team noted that depression and anxiety rates in this U.S. sample outstripped several pre-pandemic and early-pandemic reports from China and elsewhere. Studies like those by Liu and Cao, which tracked distress during outbreaks, saw elevated symptoms—but the Texas A&M numbers, especially for moderate-to-severe depression and anxiety, were clearly higher. That's not a horse race. It's a reminder that context matters—culture, economics, health systems, and the particulars of how a university shut down and communicated can all shape what students feel. Let's talk about the design, briefly, because it frames what we can and can't conclude. This was a cross-sectional survey—one point in time—run online during the first peak. It used validated instruments and complemented them with open-ended questions. The sample size was large, and the team didn't just eyeball differences; they tested them, reporting that gender and academic classification both had significant effects on symptom scores. But there were limits they're candid about. Who clicks a survey link in a pandemic? It might skew toward those under more strain. There was no pre-pandemic baseline for these same students, so we can't say by exactly how much an individual's symptoms changed. The sample tilted female, with sixty-one point sixty-four percent, which can influence average scores and who's represented. That said, the picture is coherent. Symptoms were common and often intense. Stressors were specific and piled up in consistent ways: academics, uncertainty, health, money, and disrupted routines. Coping relied heavily on human connection and, to a lesser degree, on technology, with formal services reaching only a small slice. Barriers—especially cost, stigma, and navigation—were widespread. If you're a university leader or a clinician, that's a clear map of where to aim. What do you do with a map like that? Start where students already are. If two-thirds are leaning on friends and family, build programs that strengthen those networks with simple, evidence-based tools—peer-to-peer workshops, brief skills training, and clear referral pathways when someone notices a friend struggling. If apps are a natural first step for some, curate and subsidize a small set with known benefits, and embed them into courses or orientation so they're not just icons on a screen. Lower the friction to formal care—expand tele-mental health, normalize screening for depression and anxiety in student health, and tackle the big barriers directly. Fees, stigma, and not knowing where to go are solvable problems if you decide they're core to the mission, not extras. The story here isn't that college students are uniquely fragile. It's that they were uniquely exposed to a perfect storm: dislocation, uncertainty, and high stakes with little control. Wang and colleagues caught that moment in detail—who struggled, how, and what they reached for. We're past the first surge now, but the lesson travels. In any future disruption—pandemic, natural disaster, or campus-wide strike—the same logic applies. Measure what's happening with tools that capture both symptoms and lived experience. Act on the obvious barriers. And put people, not platforms, at the center, with technology as the bridge, not the destination.

That abrupt pivot didn't just shuffle classes online. It disrupted routines, scattered support networks, and turned the most social years of life into an isolation experiment. Students were already walking a mental health tightrope.

A year before the pandemic, the Center for Collegiate Mental Health's annual report flagged anxiety as the most common problem among counseling center clients, with sixty-two point seven percent out of more than eighty thousand students. So, when COVID hit, the question wasn't if stress would rise on campus. It was how high, for whom, and what might help.

Wang and colleagues at Texas A&M set out to take that snapshot at the exact moment the ground gave way. They ran an online survey in the late spring of 2020, from May 4 through May 19, right in the first surge. Invitations went to the entire College Station student body, which was more than sixty thousand people, and two thousand thirty-one responded.

The study did two things at once. It measured depression and anxiety with standardized tools—the Patient Health Questionnaire-9 for depressive symptoms and the Generalized Anxiety Disorder-7 for anxiety—and it listened. It asked students to name the stressors they faced, the coping strategies they actually used, and the barriers that kept them from care.

Then it tied those pieces together, statistically and thematically, to show the lived picture of mental health on a big U.S. campus when the pandemic doors slammed shut.

Here's the headline. Almost half of surveyed students fell into the moderate-to-severe range for depression, with forty-eight point fourteen percent. More than a third were in that same range for anxiety, at thirty-eight point forty-eight percent.

Nearly one in five, or eighteen point four percent, reported suicidal thoughts in just the two weeks before they answered the survey. When asked directly about how their stress changed, seven in ten said it went up during the pandemic. Only five percent said it went down.

When pressed on whether they felt able to cope, forty-three point twenty-five percent said yes, fifteen point eighty-four percent said no, and the rest weren't sure. That uncertainty is its own kind of alarm bell.

If you pull back from the strict "moderate-to-severe" cutoff and look at any symptoms at all, the scope grows. Of one thousand nine hundred ninety-four complete Patient Health Questionnaire-9 responses, eighty point fifty-seven percent scored five or higher, which means some level of depression. Most were in the mild to moderate bands—about a third mild, a quarter moderate—but a substantial block landed in the heavier tiers, with fifteen point eighty-five percent moderately severe and seven point forty-two percent severe.

Anxiety followed a similar arc. Out of two thousand fourteen complete Generalized Anxiety Disorder-7 responses, seventy-one point seventy-five percent reported at least mild anxiety, with roughly a third mild, about a quarter moderate, and fourteen point eighty percent severe. And those suicidal thoughts?

Three hundred sixty-six students said yes; most reported that the thought occurred "several days," some said "more than half the days," and a smaller group said "nearly every day."

Not everyone was hit equally. When Wang's team compared groups, two patterns stood out. Gender mattered, and place in the academic ladder mattered.

Using a two-way analysis of variance—think of it as checking how two factors, like gender and student classification, each nudge average scores—they found significant effects across the board. Women reported higher symptoms, by one point seventy-six on the Patient Health Questionnaire-9 and two point twenty-two on the Generalized Anxiety Disorder-7. Effect sizes were modest but real.

Students further along in their programs tended to score lower than those earlier on. Doctoral students, for example, had significantly lower depression and anxiety scores than undergraduates; even among undergraduates, seniors fared better than freshmen on depression. Master's students often fell in between, with a notable difference from sophomores on anxiety.

The pattern doesn't say who is "resilient" and who isn't. It indicates that context—where you are in your training, how much structure you have, and how much uncertainty you face—showed up in these numbers.

What was weighing on students day to day? When you read the open responses, a rank order emerges. Among the one thousand three hundred sixty students who explained why their stress rose, academics topped the list—thirty-nine point twelve percent pointed there first.

The reasons were concrete: an abrupt shift to online classes that didn't feel like a simple swap, worries about grades, and fear that graduation might slip. Right behind, an almost identical share named the fog of pandemic uncertainty itself at thirty-four point seventy-eight percent, and health concerns at thirty-four point seventy-one percent—not just fear of catching COVID, but worry about the mental health toll and the safety of parents and grandparents. Money troubles entered for about one in five, and changes to living and work environments—working from home, cabin fever, and moving back in with family—also sat in that same neighborhood at just over twenty percent.

Social life took a hit for many, with eighteen point fifty-three percent naming isolation or lost community as a main stressor. A handful even reported less stress, usually because commutes vanished and schedules loosened. For them, time was a pressure valve.

Academic strain wasn't just about vibes; it showed up in the checkboxes, too. Nine out of ten students, or ninety point seventy-four percent, reported trouble concentrating. Almost as many worried about academic progress and future plans, at eighty-nine point fifty-seven percent.

Three out of four students, or seventy-six point zero three percent, said adapting to distance learning was a challenge. That's a lot of cognitive load piled on top of a moving target.

Health and daily rhythms were bending, too. Nearly nine in ten, or eighty-nine point twenty-four percent, expressed concern about their own health or that of loved ones. Sleep changed for the vast majority, with eighty-four point ninety-two percent saying so, and eating patterns shifted for eighty point forty-four percent.

Two-thirds reported depressive thoughts. Those are the kinds of changes that don't just reflect stress—they amplify it. Sleep, diet, mood: they're the scaffolding. When they wobble, everything feels shakier.

So, what did students actually do to cope? The first line wasn't an app or a campus service. It was people.

Sixty-seven percent leaned on support from family, friends, or their broader communities. Technology played a supporting role—about a third used websites, mobile apps, or even sensors to manage stress—but uptake of university services was much lower. Roughly one in ten used campus counseling, and fewer tapped campus health services for mental health.

Notably, one in five said they used no coping mechanism at all. Among those who did describe specific tactics, exercise topped the list, alongside meditation, reading, music, creative outlets, and spiritual practices. A subset mentioned what we'd call negative coping—distraction, isolation, alcohol, even self-harm—signaling needs that weren't being met elsewhere.

A quick tour through the technology side reveals a niche but telling pattern. About fourteen point twenty-eight percent used mobile apps specifically for stress management, and among the nearly three hundred who named names, mindfulness dominated. Roughly seventy-two percent of those app users chose meditation or breathing apps—think Headspace, guided relaxation, and simple timers that teach you to pause.

That doesn't tell us the apps worked. It tells us which tools felt approachable in the crush of change.

Where were students getting their pandemic information? From the institutions closest to them. University emails were the most common source, at sixty-one point eighty-nine percent, followed closely by newspapers and periodicals at sixty point twelve percent.

Social media fed half the sample. Medical websites and providers trailed behind, which makes sense when speed beats nuance and inboxes win the attention race.

Now, the other side of the ledger: when students wanted help, what got in the way? Money, stigma, and simple lack of knowledge. Financial barriers—fees and insurance—were cited by seventy point sixty-one percent of respondents.

Social stigma came next at fifty-eight point seventy-nine percent, then lack of information about available resources at fifty-four point eleven percent, and limited access to services at forty-eight point fifteen percent. In the open comments, some students named self-imposed barriers—hesitation, doubts about whether treatment would help, discomfort talking about mental health, or worries about quality. None of these are abstract problems.

They're the potholes you hit on the way to care, especially when the road itself is new.

So, how does this campus snapshot fit into the broader scientific picture? It's high. Wang's team noted that depression and anxiety rates in this U.S. sample outstripped several pre-pandemic and early-pandemic reports from China and elsewhere.

Studies like those by Liu and Cao, which tracked distress during outbreaks, saw elevated symptoms—but the Texas A&M numbers, especially for moderate-to-severe depression and anxiety, were clearly higher. That's not a horse race. It's a reminder that context matters—culture, economics, health systems, and the particulars of how a university shut down and communicated can all shape what students feel.

Let's talk about the design, briefly, because it frames what we can and can't conclude. This was a cross-sectional survey—one point in time—run online during the first peak. It used validated instruments and complemented them with open-ended questions.

The sample size was large, and the team didn't just eyeball differences; they tested them, reporting that gender and academic classification both had significant effects on symptom scores. But there were limits they're candid about. Who clicks a survey link in a pandemic?

It might skew toward those under more strain. There was no pre-pandemic baseline for these same students, so we can't say by exactly how much an individual's symptoms changed. The sample tilted female, with sixty-one point sixty-four percent, which can influence average scores and who's represented.

That said, the picture is coherent. Symptoms were common and often intense. Stressors were specific and piled up in consistent ways: academics, uncertainty, health, money, and disrupted routines.

Coping relied heavily on human connection and, to a lesser degree, on technology, with formal services reaching only a small slice. Barriers—especially cost, stigma, and navigation—were widespread. If you're a university leader or a clinician, that's a clear map of where to aim.

What do you do with a map like that? Start where students already are. If two-thirds are leaning on friends and family, build programs that strengthen those networks with simple, evidence-based tools—peer-to-peer workshops, brief skills training, and clear referral pathways when someone notices a friend struggling.

If apps are a natural first step for some, curate and subsidize a small set with known benefits, and embed them into courses or orientation so they're not just icons on a screen. Lower the friction to formal care—expand tele-mental health, normalize screening for depression and anxiety in student health, and tackle the big barriers directly. Fees, stigma, and not knowing where to go are solvable problems if you decide they're core to the mission, not extras.

The story here isn't that college students are uniquely fragile. It's that they were uniquely exposed to a perfect storm: dislocation, uncertainty, and high stakes with little control. Wang and colleagues caught that moment in detail—who struggled, how, and what they reached for.

We're past the first surge now, but the lesson travels. In any future disruption—pandemic, natural disaster, or campus-wide strike—the same logic applies. Measure what's happening with tools that capture both symptoms and lived experience.

Act on the obvious barriers. And put people, not platforms, at the center, with technology as the bridge, not the destination.

Related lectures