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Is course delivery model (entirely online vs mix of online and in-person classes) associated with college students’ mental health?

In a recent study published in JAMA Network Open, researchers assessed the association between the model of course delivery and mental distress among students attending college in the United States (US).

Study: Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic. Image Credit: fizkes/Shutterstock


Studies have reported elevated anxiety and depression rates among students of US colleges during the coronavirus disease 2019 (COVID-19). The sudden transition of course delivery from in-person offline to remote online models to curtail SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) transmission and mitigate COVID-19 has affected mental health.

Factors such as geographical relocations, lack of social interactions, and limited access to technology and/or the internet have added to the psychological distress. However, the link between remote schooling and mental health has not been extensively investigated.

About the study

In the present cross-sectional study, researchers investigated whether the type of model selected for delivering college courses affected the mental health of undergraduate students in the US.

De-identified and national-level data were obtained from the ACHA (American college health association)–NCHA (national college health assessment III) survey through inline surveys sent to students enrolled for full-time four-year undergraduate courses in spring 2021 between January and early June 2021.

The study exposure was the self-reported model of course delivery. Based on the Kessler psychological distress screening scale scores, the study outcome and measures comprised psychological distress. The scale comprised six questions on students’ experience of feeling nervous, hopeless, worthless, restless, or upset to such an extent that nothing could cheer them up or that everything required effort during the previous 30 days.

The course delivery model variable was assessed based on questions about whether the students attended classes completely in-person, remotely, or as a hybrid model, including both on-site and online/remote classes. In addition, the student’s residence was assessed as living in a sorority or fraternity residence, on-campus or university accommodation, or at off-campus places, including homes of parents/guardians/other family members.

Covariates analyzed included sociodemographic variables, current depression and/or anxiety status, duration of socializing, and concerns related to the pandemic. Individuals were excluded if they documented no place to reside or lived at a friend’s place. In addition, those with missing information for the variables assessed and those attending classes completely in-person were excluded from the analysis.

Multiple linear regression models were used for the analysis, with psychological distress assessment as an independent variable, covariate adjustment, and socialization variable inclusion in the first, second and third regression models, respectively.

Results and discussion

A total of 59,250 students were considered for the final analysis, excluding those with no place of residence or living at friends’ homes (0.10%), those with missing information (five percent), and those attending classes entirely in-person (four percent). Most students (68%) were White females, with an average age of 21. Among the study participants, 61% and 35% attended classes entirely online and as a hybrid model comprising in-person/on-site and remote/online classes, respectively.

Students who opted for entirely online classes entirely online documented significantly greater levels of mental distress compared to students who opted for the hybrid mode comprising partly online and partly face-to-face classes. The positive association between remote schooling and psychological distress continued to be statistically significant after the team controlled for geographical location, academic year, sex, ethnicity, race, security of food, current depression/anxiety status, residence, pandemic concerns, and socializing duration.

Among the students, 20% and 16% documented the presence of anxiety and depression, respectively, and 64% documented high food security levels. Of the participants, 29%, 37%, and 34% resided on the college campus, outside campus with their families, and off-campus in another type of accommodation, respectively. Nearly half (49%) of the students socialized for≥6.0 hours weekly, whereas 41% of the college students socialized for one hour to five hours weekly. No socialization was reported by 10% of the students.

Students attending classes entirely online socialized the least, with 12.0% of students not socializing at all compared to five percent of students opting for the hybrid model for course delivery. Further, students residing in other (non-family) off-campus types of accommodation documented significantly lesser psychological distress than students living on campus.

The association continued to be statistically significant even after the team controlled for socialization. Students living at family homes documented more psychological distress than students who resided on campus; however, the association was non-significant after the team controlled for socialization.

Student culture is altered significantly with completely online models. In contrast, the hybrid model permits normalcy to some extent due to so inclusion of on-site or face-to-face experiences with informal social interactions and engaging in extracurricular activities. In addition, students could feel distracted and may procrastinate during online schooling, with reduced motivation for class participation due to a lack of face-to-face communication.

Online teaching methods may differ from those used for in-person teaching, which may be a source of academic frustration among the students. However, factors other than socialization also seemed to affect students’ mental health.


Overall, the study findings showed that fully online course delivery was associated with greater psychological stress among undergraduate students, even though the conversion of the teaching model has been essential for mitigating the SARS-CoV-2 pandemic.

The findings indicated that academic institutions must precisely weigh the risk and benefit ratio when selecting the type of model for course delivery, and the impact on the mental health of the students must not be neglected.

Journal reference:
  • ElTohamy, A. et al. (2022) "Association Between College Course Delivery Model and Rates of Psychological Distress During the COVID-19 Pandemic", JAMA Network Open, 5(11), p. e2244270. doi: 10.1001/jamanetworkopen.2022.44270.

Posted in: Medical Science News | Medical Research News | Disease/Infection News

Tags: Anxiety, Coronavirus, Coronavirus Disease COVID-19, covid-19, Depression, Food, Mental Health, Pandemic, Respiratory, SARS, SARS-CoV-2, Severe Acute Respiratory, Severe Acute Respiratory Syndrome, Stress, students, Syndrome

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Pooja Toshniwal Paharia

Dr. based clinical-radiological diagnosis and management of oral lesions and conditions and associated maxillofacial disorders.

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