Impact of COVID-19 on the psychological and behavioral health of college students worldwide: a knowledge mapping approach

Time distribution analysis

Examination of publication time showed that, since the outbreak of COVID-19 in December 2019, research on the impact of the pandemic on college students’ psychological and behavioral health showed an increasing trend year by year, but a decreasing trend in 2023. The number of published papers in 2020 was the lowest, at only 38 papers. This may be because the pandemic broke out globally at the end of 2019, and pandemic prevention and control began around the world. The impacts on people’s lives, work, and study had not yet emerged, resulting in relatively few relevant studies. The time spent in the home office and online learning increased, especially for college students enrolled in 2019 who had experienced 3 years of pandemic containment that started soon after they entered school, this means that most of their time was spent in online courses at home or on campus. As time progressed, the uncertainty caused by the pandemic had a continuous impact on college students’ psychological and behavioral health, and related research also increased. The number of studies peaked in 2022. As the virulence of the virus weakened, control conditions around the world began to relax. By the end of 2022, most countries had revoked pandemic control, people’s lives had returned to a pre-pandemic state, students had returned to school, and the impact of the pandemic was slowly decreasing; therefore, related research also decreased (Appendix 1).

Core author analysis

In total, 246 authors were identified, with the top four authors (not including the first and second authors) being Goncalves, Aurelie (four papers); Charbonnier, Elodie (four papers); and Hsiao and Pao Ying (three papers). The visualization map of the core authors of the reviewed literature showed that the connections between the authors were few and simple. This indicated that the connection density of the authors’ cooperative relationship network was low, the connection scale was small and scattered, and only some scholars had cooperated twice or more (e.g., Liu Jin, Ha Mengying, and Liu Zhen). The calculation formula of core authors using Price’s law is mp = 0.749√(npmax), where npmax is the number of papers published by the author with the largest number of publications during the statistical period, and mp is the minimum number of publications by the core author. The core author group is formed when the number of papers published by the core author is above mp, and the papers written by the core author reach 50% of all papers in the field. It showed npmax was 4 and mp was 1.5, which meant that the authors who had published more than two papers were the core authors in this research field. The statistical analysis showed that 10 authors had published more than two relevant papers and a total of 29 papers had been published, accounting for 3.6% of the sample literature. However, as this was far from 50% of the literature, a core group of authors in this research field had not yet formed (Table 1 and Appendix 2).

Analysis of major journals

The top 20 journals published a total of 561 relevant papers, which accounted for 70% of all identified papers. The journals with the highest number of publications were the International Journal of Environmental Research and Public Health (178 articles), Psychiatry Research (121 articles), and PLOS One (91 articles). These publications mainly covered public health, mental illness, emotional disorders, medicine, and other research fields. The journal with the highest impact factor was The Lancet, which had an impact factor of 168.9 in 2022, making it one of the top four journals in the medical field. This showed that the academic quality and influence of studies on the impact of the COVID-19 pandemic on college students’ psychological and behavioral health had been recognized by authoritative international journals. The centrality of multiple journals in the journal co-occurrence graph was high, with the Journal of Affective Disorders having the highest centrality (0.08). Strong centrality journals were closely connected, indicating that there were many cases in which these journals appeared in the same literature at the same time (Table 2 and Appendices 3 and 4).

Research institution analysis

Analysis of the distribution of core research institutions can reflect the research status of college student’s mental health and behavior in a particular field, and the corresponding strength and academic influence of the research team can be further reflected through statistics showing the number of published papers from each research institution. Twenty institutions published 98 core articles, accounting for 13% of all relevant literature. Chinese universities accounted for 50% of these institutions, indicating that China paid more attention to research on the impact of COVID-19 on college students’ psychological and behavioral health, with Fordham University, Huazhong University of Science and Technology, and Sichuan University ranked as the top three. Among these institutions, Huazhong University of Science and Technology has a major academic influence on clinical medical research. It is in Wuhan, which had the earliest outbreak points of the COVID-19 pandemic in China; therefore, this institution had a deep concern about the impact of the pandemic, and there were many related studies. The co-presence chart of research institutions showed that the centrality of several research institutions was high, among which Beijing Normal University had the highest centrality (0.02). The number of papers published by Beijing Normal University also ranked at the forefront, which indicated that Beijing Normal University, as the national leader in education and psychology, paid great attention to college students’ psychological and behavioral health and had relatively rich research results (Appendix 4).

Country analysis

The analysis of the countries that issued publications reflected the attention paid by different countries to pandemic prevention and control and the development of college students in the field of higher education. We found that research in this field was conducted in 93 different countries. The ranking of the top 20 countries is shown in Table 2. The top three countries were the United States (215 articles), China (167 articles), and the United Kingdom (49 articles). The three countries with the highest centrality were the United Kingdom (0.34), the United States (0.24), and Mexico (0.13), which showed that a core group of countries had formed in this field, and the countries at the center of public opinion during the pandemic also included these countries. Different countries adopted different modes of fighting the pandemic; for example, the United States focused on “herd immunity,” the United Kingdom tended to “co-exist with the virus,” and China adopted a “zero elimination” approach of strict prevention and control. Different anti-pandemic measures also showed the differences in different countries’ systems and had an important impact on the economic development of that country and the healthy lifestyles of the population. In the context of the pandemic environment, national research on the impact of the pandemic was conducive to promoting the respective countries to implement effective response and management measures (Appendix 5).

There are some potential reasons and implicit contexts for exploring why and how the United Kingdom, the United States, and Mexico are the countries with the highest concentration in this area of research. For example, during the COVID-19 period in the UK, the degree of policy tightness has continued to repeat, and the overall prevention and control measures are gradually relaxed. The number of British adults vaccinated against the new coronavirus is among the highest in the world, but active vaccination cannot completely protect against the new strain after mutation, so the British people gradually break the prevention and control policy has begun to “coexist with the virus” (Samuolis et al., 2023). At the same time, in the process of fighting the novel coronavirus, the British economy has suffered a huge challenge. In the context of “Brexit”, especially under the impact of the COVID-19, Britain’s economic recovery has always lagged behind other large economies. The adverse effects of the new coronavirus and the difficult rebound of the economy have a very serious impact on the normal life of the British people. How to make production, life, and learning gradually get on the right track in such an environment is an urgent issue for researchers to explore. As the world’s largest economy, the United States has the most advanced medical technology and the most powerful medical system (Borges et al., 2023; Buizza et al., 2022).

Since the outbreak, the data from the Coronavirus Resource Center of Johns Hopkins University in the United States shows that the number of confirmed cases and deaths in the United States occupy the first place in the world, and the people’s livelihood has been greatly affected. The most important reason is the deformed medical system in the United States. The monopoly of big capital in the medical industry causes high medical costs in the United States. The defects in public health governance make the United States lack unified, timely, and effective response measures in the face of major pandemics, resulting in people’s doubts about the government. In the later period of COVID-19, under the guidance of the “herd immunity” prevention and control policy in the United States, COVID-19 had a more far-reaching impact on people’s lives, work, and study, so the research on this has become an urgent need for scholars to form effective policy planning. Mexico is geographically located in the southern part of North America, but is politically and culturally part of Latin America, and has the second largest population in the region, and is also the main source country of the 2009 H1N1 influenza, although it has experienced health management of previous influenza outbreaks (Samuolis et al. 2023). In addition, Mexico still faces problems such as insufficient investment in public health, backward public health infrastructure, and a loose health system, so livelihood protection has become the biggest risk in Mexico during the COVID-19 pandemic. As a typical country with health capacity in the region, there is abundant research on pandemic prevention and control in Mexico (von Keyserlingk et al., 2022).

Analysis of research hotspots

Keywords are an indispensable part of academic papers and offer a high level of generalization of the content of academic papers. Therefore, keyword co-word analysis can reveal the research hotspots in a particular field. In this study, the research topics reflected by the keywords with high centrality and word frequency were the research hotspots in this field. We imported the 796 filtered papers into CiteSpace software, selected “keyword” for the node type, set the time span to 2020–2023, and set the time slice to 1 year. A keyword co-occurrence graph (Fig. 2) was obtained after running the analysis. The more keywords appear, the larger the square in the picture; the font size is the embodiment of the centrality of keywords, and a larger font indicates stronger centrality. To present the research hotspots in this field more clearly and intuitively, data such as keyword word frequency and centrality were exported from the background of CiteSpace software, and the top 20 keywords with the highest frequency were sorted (Table 3). Keyword occurrence frequency and centrality are not necessarily positively correlated. The higher the keyword frequency, the more it occurs, and the research topic appears repeatedly. The higher the centrality of the keyword, the stronger the mediating effect, which indicates the keyword has a greater influence on other keywords.

The top five keywords were “mental health,” “college students,” “depression or sadness,” “stress,” and “anxiety.” As the topic of our analysis was “college students” and “mental health and behavior,” the search terms included these words, so it was necessary to remove the words “college students” and “mental health.” A research hotspot is indicated when the centrality of a keyword is above 0.1. A comprehensive consideration of the frequency and centrality of keywords in our study showed the main research hotspots in this field were psychological stress, behavioral disorders and mental disorders, and risk perception (Table 3 and Fig. 2).

Psychological stress

The COVID-19 introduced many stressors into college students’ daily and academic lives. Various studies explored whether learning stress among students increased after the pandemic and how individual and situational factors modulated this potential increase in stress. Based on longitudinal survey data for stress levels and self-regulation efficacy among students in a public university before and after the outbreak of the pandemic, a regression analysis showed that the level of learning-related stress generally increased after the pandemic outbreak. Students with self-efficacy reported a lower increase in stress in self-regulation than those without self-efficacy. A greater increase in stress was associated with higher levels of mental health impairment and less school time. To solve the stress problems of students, universities should provide students with resources with corresponding solutions, so that their self-psychological regulation and time management ability can be improved (von Keyserlingk et al., 2022). Another study examined stress and coping styles during a pandemic lockdown at a United States university campus and included a scale to assess coping strategies and perceived stress. The results of the study showed that the stress generated during the lockdown was related to negative coping strategies such as emotional denial and behavioral detachment. Stress was negatively correlated with positive coping strategies, such as acceptance, planning, and positive coping. Therefore, it was recommended that during the lockdown period, health education efforts should focus on stress screening for students, providing mental health services and coping skills-related information sessions to students, as well as providing virtual recreation and social opportunities (Samuolis et al., 2023).

Behavioral and mental disorders

“Disorder” has two different meanings in literature. One refers to behavioral disorders, such as sleep and eating disorders, and the other refers to various mental disorders, such as post-traumatic stress disorder (PTSD) and attention deficit hyperactivity disorder (ADHD). It has shown that periods of economic “pause” and quarantines are likely to lead to risky health behaviors, such as increased self-abuse, drinking and eating irregularly, smoking, drug use, and alcohol consumption. Although the impact of the pandemic on people with eating disorders remains unknown, it may have contributed to increased eating disorder symptoms (e.g., dietary restriction, overeating, emotional eating) (Fila-Witecka et al., 2021). A study focused on sleep problems among Polish college students during the pandemic and the relationship between the severity of insomnia symptoms and psychopathological symptoms, PTSD, and behavioral factors showed that more than half of the students had a certain form of sleep disorder and suggested that sleep problems may be widespread among college students. In addition, although symptoms of insomnia and the severity of sleep disorders were significantly associated with all studied variables, the direction of these associations remains to be determined (Fila-Witecka et al., 2022; Takeda et al., 2023).

Risk perception

Both the absolute risk on the surface and the perception of implied risk were the focus of research on the potential risks associated with the pandemic. COVID-19 increased the risk for disease in the superficial sense (physical and mental illness), and some studies used random-effects models to calculate the combined prevalence by conducting narrative reviews to identify risk factors during the pandemic. The main risk factors identified were female gender, early school or pre-clinical years, exposure to COVID-19, academic stress, history of mental or physical illness, financial hardship, fear of impaired education, online learning difficulties, fear of infection, loneliness, low physical activity, low social support, and problematic Internet or smartphone use. During COVID-19, there has been a significant increase in mental health issues and related risk factors, which requires guidance on mental health. These findings are crucial for universities and health authorities to identify students at mental health risk and provide corresponding intervention measures (Peng et al., 2023). Furthermore, people’s perception of risk affected their preventive behavior during the pandemic. A study focused on Chinese university students and analyzed their sub-types of risk perception in COVID-19, identified the characteristics of these sub-types, and investigated the potential profile and influencing factors of risk perception. The results showed that pandemic risk cognition among Chinese college students was not ideal and had significant group characteristics and heterogeneity. Universities and public health practitioners can identify potential sub-populations to provide a theoretical and empirical basis for implementing risk perception interventions during outbreaks (Gan and Fu, 2022). People’s perception of risk also affected their emotional state during the pandemic. It is also shown that the risk and time perception of college students are significantly correlated with their mental health. Therefore, in the event of a sudden public health emergency, it is important to closely monitor the mental health status of college students, promptly adjust their attitudes towards the present and future, and consider their risk perception ability, to improve their mental health level in times of crisis (Cao et al., 2021).

Core theme analysis

The keyword clustering function in CiteSpace software is based on keyword co-word analysis; the analysis object (frequency) is subject to a clustering statistical algorithm, which simplifies the complex co-word relationships between many objects into relatively clear relationships between several class groups. This means the collection of topics with high correlation in a certain time can be intuitively summarized to reveal thematic trends in the research field. Using keyword cluster analysis and the log-maximum-likelihood rate algorithm, we drew a clustering time diagram (Fig. 3) that included 17 clustering results. Based on the similarity of clustering centers, 17 clusters were divided into five core topics (Table 4 and Fig. 3).

Cluster one: Mental health

The keyword “mental health” had a frequency of 373. Similar research topics included “psychological tolerance” and “psychological adjustment,” which also had a high frequency. The CiteSpace cluster summary table showed that since the outbreak of COVID-19, scholars have paid continuous attention to the psychological health of university students, and research in the field of mental health showed a rapidly rising trend from 2020 to 2022. After 2023, although the overall number of publications decreased, the proportion of studies on mental health remained large. Scholars mainly focused on cross-sectional research examining college students’ psychological endurance, psychological resilience, and adjustment effect.

Cluster two: Academic stress

The word frequency and centrality of “stress,” “anxiety,” and “online learning” were all at a high level. The keyword time zone table showed that since the outbreak of COVID-19, all students were studying online at home, which caused anxiety and distress for students; therefore, research on academic stress among college students showed an increasing trend. Research conducted in this area mainly focused on college students’ study habits, online learning satisfaction, self-efficacy, and academic pressure in the context of the COVID-19 pandemic. In addition, research focused on college students’ teaching methods, online teaching quality, and online interaction quality during the COVID-19 pandemic.

Cluster three: Physical health risks

The frequency of both “physical activity” and “health risk” were high. As shown in the keyword clustering time graph, the outbreak of COVID-19 meant people could not go out for physical exercise. Therefore, the impact of COVID-19 on health became a hot topic for many scholars and included research on college students’ physical health status, sports activity plans, and similar topics.

Cluster four: The major of college students

Since the spread of COVID-19 disease, college students have been a key area of concern, although the impact of the pandemic on various majors varied, with more words related to “medical students.” In addition, the keywords displayed in the keyword clustering time graph involved research topics such as freshmen, non-autistic students, and sports majors.

Cluster five: Living habits

The research on living habits mainly focuses on the changes in college students’ lifestyles, eating habits, and weight during COVID-19. Comparative research methods are commonly used to test and analyze the lifestyle habits of college students from different countries. Relevant research has made a comparative study on the impact of China, Spain, Indonesia, the United States, and other countries on college students’ living habits during the COVID-19.

Cutting-edge research analytics

A research frontier can be described as a set of scientific issues discussed in a certain period based on burst articles. A research frontier can be identified based on an analysis of burst terms, with comprehensive judgments and detection in combination with the analysis of relevant cited documents. The visual burst detection results obtained using CiteSpace software (Fig. 4) showed 10 emergent keywords in the literature related to the impact of the COVID-19 pandemic on the psychological and behavioral health of college students from 2020 to 2022, all of which represented topics with increasing research trends. These topics included mental healthcare, mental resilience, happiness, psychological impact, and medical students (Fig. 4).

Ongoing impact of COVID-19 on college student’s mental health

The COVID-19 makes people pay more and more attention to the psychological health of the disadvantaged college students. It shows that the mental health of college students during COVID-19 is worse than that of other groups. (Kang et al., 2021; Lovell et al., 2015) Not all studies indicate that the mental health problems of college students have worsened during this period. Some studies have found that the mental health problems of college students are declining or stabilizing, which is exactly the opposite of the situation mentioned earlier. Carpinelli et al. (2021) showed that disabled students and students with special learning disabilities are more satisfied with remote teaching than normal students. Only 22% of disabled students expressed dissatisfaction with the teaching methods used due to difficulties, including those related to weak technological infrastructure. Ding et al.’s study showed that sedentary behavior, challenges of online learning, feelings of isolation, and concerns about COVID-19 infection led to poor psychological and overall health among college students, but the results showed that most respondents reported good overall health. Related studies have shown that providing face-to-face learning experiences at an accelerated pace without addressing the underlying causes of mental health issues may not necessarily have a positive impact on student’s mental health. In general, although the direct impact of COVID-19 on the deterioration of college student’s mental health has not been confirmed, it does have a negative impact on some college students to varying degrees.

The COVID-19 outbreak in 2019 caused deep and lasting psychological damage. Medical students were at high risk for psychiatric problems during the COVID-19 pandemic, possibly because of the high risk for infection, major lifestyle changes, severe restrictions, and disruption to education (Elmer et al., 2020). Research also showed high prevalence rates of depression, anxiety, and sleep disorders among medical students worldwide during the pandemic. These common psychological problems may lead to the abandonment of medical studies. The lockdown of medical research institutions during the COVID-19 pandemic and the new challenges facing global healthcare systems had a dramatic impact on the quantity and quality of medical education. Therefore, the COVID-19 pandemic impacted medical students’ academic performance, as they were faced with learning challenges involving clinical skills and practical aspects such as laboratories. During the pandemic, medical students faced a higher risk for COVID-19 infection than other majors, which introduced additional psychological pressure for these students. Medical students have close contact with patients and their families because of their practical learning needs and work requirements. However, most young medical students lacked clinical experience, and the possibility of contact with patients with COVID-19 and the risk for infection was significantly increased compared with students from other majors. In addition to the “new” pressures brought about by the pandemic, original pressures based on exams, experiments, papers, and workloads were exacerbated by the pandemic. Students preparing for employment and graduation theses were under a greater psychological burden, as social communication was somewhat limited, traditional learning processes were disrupted, completion of expected academic work was disrupted, and heavy clinical responsibilities became a source of anxiety for students. In general, medical students, as the “reserve army” of future medical teams, should receive more attention in such situations. Relevant research focused on the psychological problems among residents, graduate students, undergraduates, and nurses at different levels. The results suggested that the COVID-19 pandemic had different degrees of impact on the psychological state of medical students, with stress stemming from fear of disease, worry about the pandemic, and anxiety about studies. Affected students showed obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, fear, and high scores for psychotic factors. These psychological problems in medical students occurred not only during the outbreak period but also in the post-pandemic era. Medical universities should consider the students’ mental health and medical personnel during a pandemic situation, establish a prevention and treatment system for psychological problems, take effective measures to prevent the occurrence of psychological problems, identify problems early, and provide targeted psychological treatment.

Mediating role of college students’ mental resilience during COVID-19

Psychological resilience refers to an individual’s ability to recover from adversity, setbacks, and failures, and is the ability to adapt, regulate, and “bounce back” psychologically when facing difficulties. This ability is related to an individual’s physical and mental health, career success or failure, and happiness index. The strength of psychological resilience reflects a person’s ability to adapt psychologically and their perseverance and determination in the face of difficulties. Psychological resilience not only helps us overcome difficulties but also promotes the process of psychological recovery, making us stronger and more energetic. Therefore, psychological resilience plays an important role in college students’ response to the changes in COVID-19. It can help college students better cope with setbacks and difficulties, enhance their self-regulation ability, and restore their mental health. When facing difficulties in academic performance, interpersonal relationships, and future planning, psychological resilience can make them more optimistic, resilient, and proactive in coping, thereby better-solving problems. In addition, the level of psychological resilience can have varying degrees of impact on individuals and directly affect the degree of anxiety and depression. People with high psychological resilience can self-regulate and relieve stress when experiencing stress, while those with low psychological resilience are more likely to experience anxiety and depression symptoms due to their weaker ability to resist adversity. Li and Xie (2022) mentioned that relevant research has investigated the mediating role of psychological resilience. Psychological resilience plays a protective mediating role in mental health issues such as stress, depression, fatigue, and anxiety, indicating that psychological resilience is a key factor in understanding stress and predicting anxiety. However, when college students face enormous pressure, it may lead to a decrease in their original level of psychological resilience. Overall, the psychological resilience of college students can be an important direction for future research, and intervening in their psychological resilience can help alleviate the impact of sudden public health emergencies on their mental health.