Awadalla, Suheir
(2021)
The impact of depression and anxiety on academic performance among university students in UAE: evaluating a CBT-based online intervention in academically struggling students with low mood.
PhD thesis, University of Nottingham.
Abstract
Rising rates of university students experiencing symptoms of depression and anxiety have been observed, both of which affect cognitive function. While some studies suggest that depression can significantly impact and impair students’ academic performance, study satisfaction, and general well-being, the relationship between anxiety and academic outcomes is perhaps more complex.
Academic success is a crucial concern for university students; therefore, understanding how depression and anxiety and university academic experiences affect each other is critical. While options for effective treatments are widely available, these disorders are often under-diagnosed and under-treated. Recent literature suggests an increasing need for accessible and confidential mental health services to support university students suffering from psychological and/or academic difficulties. Student populations use technology at a high rate. Though online interventions can effectively improve university students’ mental health, their impact on educational attainment has not been fully explored.
This PhD study aims to systematically review evidence for a relationship between anxiety and depression and academic performance in university students, to examine the hypothesis that higher levels of depressive or anxiety symptoms will be associated with poorer academic performance among university students, and investigate the potential effectiveness of a self-directed, internet-delivered cognitive-behavioural skills training tool (MoodGYM) in improving academic performance (GPA) and mood of university students in the UAE.
Chapter one provides an overview of depression and anxiety in university students, a literature review of the prevalence of emotional disorders in this group, the impact of anxiety and depression on on academic outcomes, and the role of online interventions in supporting students’ mental health literacy in improving management and help-seeking for depression or anxiety. Through a systematic review, study One (Chapter Two) explores the evidence for the impact of emotional disorders (anxiety or depression) on university students’ academic performance. Of 2,746 citations, 10 met the eligibility criteria, of which six cross-sectional analyses and three of four longitudinal studies reported a negative relationship between depression and academic performance. Three cross-sectional analyses and one longitudinal study reported a negative relationship between anxiety and academic performance. This review supports a consistent relationship between depression and academic performance, but less support for anxiety. Study Two (Chapter Three) describes a longitudinal representative survey of depression, anxiety and academic achievement in 404 students from a public university in the UAE with a six-month follow-up. The survey also investigated whether the relationship between emotional disorders and academic performance is moderated by gender or socioeconomic status. The findings highlight that over a third of students (34.2%; CIs 29.7%–38.9%) screened for a possible major depressive disorder, but less than a quarter (22.3%; CIs 18.2%-26.3%) screened for possible generalised anxiety disorder. The cross-sectional analysis found that higher levels of depression and anxiety were significantly but weakly associated with poor academic performance. The longitudinal analysis found that depression, but not anxiety, predicted a poorer GPA at the six-month follow-up. Findings from these two studies were inputted into the development of the third study. It was predominantly based on exploring the potential effectiveness of a self-directed, internet-delivered, cognitive-behavioural skills training program (MoodGYM) in improving academic outcomes average and low mood in university students in the UAE with poor academic performance. Study Three (Chapter four) describes an exploratory pre-post intervention study with a historical control group of 50 students with less than 2 GPA (academically failing) and depressive symptoms from one UAE university. The findings of study three indicated a significant decrease in depression scores at post intervention (P=0.004) and the proportion of participants scoring above the cut-off for depression (HADS-D ≥8) fell from 77.2% to 27.3% (p<0.001). There was also a substantial fall in anxiety scores (p<0.001) and the proportion of participants above the cut-off for anxiety (HADS-A ≥8) fell from 50% to 11.4 % (p=0.001). GPA scores improved substantially over time (p<0.001, d=1.3) and attendance warnings reduced (p = 0.008, d = 0.6). Compared to historic control, the intervention group had higher GPA at follow-up (p < 0.030 d = 0.6) fewer attendance warnings (p = 0.036 d = 0.7). Most students (79.6%) evaluated MoodGYM as useful. More modules completed (p=0.005) and greater reduction in attendance warnings (p=0.007) were independently associated with greater improvement in GPA scores at follow-up. Chapter five considers all the evidence of the impact of emotional disorders on academic outcomes of university students, the evaluation of the online intervention, and plans for future longitudinal research for further feasibility studies.
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