Depressive symptoms as key predictor of health-related quality of life in post-COVID-19 Undergraduate Students: A multivariate analysis with EQ-5D-5L and EQ VAS 10.55131/jphd/2026/240219
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Abstract
In the post COVID-19 era, Health-Related Quality of Life (HRQoL), a multidimensional construct reflecting individuals’ physical, psychological, and social well-being, has become an important public health issue. The EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) and the EuroQol Visual Analogue Scale (EQ-VAS) are widely recognised tools for assessing HRQoL. This study aimed to evaluate HRQoL using the EQ-5D-5L and EQ-VAS and to identify predictive factors associated with HRQoL among post-COVID-19 undergraduate students. A cross-sectional survey was conducted between May and July 2023 among 451 undergraduate students. Data were analysed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman’s correlation and stepwise multiple linear regression, with the significance level set at 0.05. The mean utility score derived from the EQ-5D-5L was 0.96 (SD = 0.07), and the mean EQ-VAS score was 82.9 (SD = 14.5). Most participants reported no problems across the EQ-5D-5L domains, except for pain/discomfort (23.3%) and anxiety/depression (28.8%). Significant differences in HRQoL scores were observed based on gender, age, GPA, medical history, depressive symptoms, monthly expenses and health-related behaviours (p < 0.05). Regression analysis revealed that depressive symptoms (PHQ-9) and medical history were negatively associated with both EQ-5D-5L and EQ-VAS scores, while GPA was a positive predictor of the utility score. Age and year of study were also associated with variations in EQ-VAS scores. These findings underscore the need for mental health and academic support interventions aimed at improving HRQoL among post-COVID-19 student populations. Universities should consider providing targeted support, particularly for students in higher-risk academic years.
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References
Lee J, Solomon M, Stead T, Kwon B, Ganti L. Impact of COVID-19 on the mental health of US college students. BMC Psychol. 2021;9(1):95. doi: https://doi.org/10.1186/s40359-021-00598-3
Han Q, Zheng B, Daines L, Sheikh A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens. 2022;11(2):269. doi: 10.3390/ pathogens11020269
Wilson OWA, Holland KE, Elliott LD, Duffey M, Bopp M. The Impact of the COVID-19 Pandemic on US College Students' Physical Activity and Mental Health. J Phys Act Health. 2021; 18(3):272-8. doi: 10.1123/jpah.2020-0325.
Meregaglia M, Malandrini F, Finch AP, Ciani O, Jommi C. EQ-5D-5L population norms for Italy. Appl Health Econ Health Policy. 2023;21(2):289-303. doi: https://doi.org/10.1007/ s40258-022-00772-7
Devlin N, Roudijk B, Ludwig K. Value sets for EQ-5D-5L: a compendium, comparative review & user guide. 2022.
Pattanaphesaj J. Health-related quality of life measure (EQ-5D-5L): measurement property testing and its preference-based score in Thai population [Doctoral dissertation]: Mahidol University; 2014.
Bai G, Zhang J, Chen Y, Cao L, Yang Y, Jiang C. Health-related quality of life assessed by EQ-5D-5L and its determinants among Chinese adults. Front Public Health. 2024;12:1383781. doi: https://doi.org/10.3389/fpubh. 2024.1383781
Zhou HJ, Zhang A, Wei J, Wu J, Luo N, Wang P. Psychometric performance of EQ-5D-5L and SF-6DV2 in measuring health status of populations in Chinese university staff and students. BMC Public Health. 2023;23(1):2314. doi: https://doi.org/10.1186/s12889-023-17208-z
Xu RH, Sun R, Tian L, Cheung AW-l, Wong EL. Health-related quality of life in primary care patients: a comparison between EQ-5D-5L utility score and EQ-visual analogue scale. Health Qual Life outcomes. 2024;22(1):2. doi: https://doi.org/10.1186/s12955-023-02215-w
Figueroa-Quiñones J, Cjuno J, Machay-Pak D, Ipanaqué-Zapata M. Quality of life and depressive symptoms among Peruvian university students during the COVID-19 pandemic. Front Psychol. 2022;13:781561. doi: https://doi.org/ 10.3389/fpsyg.2022.781561
Ibirogba D, Dinesh A, Jose A, Bisheko MJ. Quality of Life assessment among post-COVID-19 undergraduates of a tertiary institution in India. Amrita J Med. 2023;19(2):79-84. doi: 10.4103/ AMJM.AMJM_12_23
Fernandes MdSV, Mendonça CR, da Silva TMV, Noll PReS, de Abreu LC, Noll M. Relationship between depression and quality of life among students: a systematic review and meta-analysis. Sci Rep. 2023;13(1):6715. doi: https://doi.org/10.1038/s41598-023- 33584-3
Khumsaen N. Knowledge, Attitudes, and Preventive Behaviors of COVID-19 among People LivinginAmphoeU-thong, Suphanburi Province. Journal of Prachomklao College of Nursing, Phetchaburi Province. 2021;4(1):33-48.
Karuniawati H, Sari N, Hossain MS, Ismail WI, Haq AHB, Yulianti T, et al. Assessment of mental health and quality of life status of undergraduate students in Indonesia during COVID-19 outbreak: A cross-sectional study. Int J Environ Res Public Health. 2022;19(19):12011. doi: https://doi. org/10.3390/ijerph191912011
Photiwat K and Silphiphat K. Factors Related to the Quality of Life of Undergraduate Students in Thailand. Rajapark J. 2023;17(55):266-82.
Melarplont S and Meebunmak Y. Happiness and Quality of Life to COVID-19 Epidemic among Nursing Students, Boromarajonani College of Nursing Ratchaburi. Journal of Boromarjonani College of Nursing, Suphanburi. 2022;5(1):67-78.
Kingsawad K and Duangchinda A. Quality of Life of Undergraduate Students during the Epidemic of Coronavirus Disease 2019 (COVID-19). J Health Sci. 2023;32(3):393-9.
Tanviboonwong P, Sungthong P, Charoenchaipinan N. Factors affecting on the quality of life of undergraduate students in Srinakharinwirot university Ongkharak. Journal of faculty of physical education. 2022;25(1):15-24.
Education Service System, University of Phayao. Report on Current Student Enrollment Statistics [Internet]. [cited 2022 May 9]. Available from: https:// reg.up.ac.th/content/all/information
Daniel WW, Cross CL. Biostatistics: A foundation for analysis in the health sciences. 10th Edition, John Wiley & Sons, Hoboken; 2013.
Bloom BS. Taxonomy of educational objectives: The classification of educational goals. New York: David McKay Company; 1971.
Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008;8:46.
O’brien RM. A caution regarding rules of thumb for variance inflation factors. Quality & Quantity. 2007;41:673-90. doi: https://doi.org/10.1007/s11135-006-9018-6
Marufi N, Malekzadeh R, Naderi F, Garmabi M, Sharifnezhad A, Darrudi F, et al. Association of depression and anxiety with health-related quality of life in beginning Medical Sciences Student. Sci Rep. 2024;14(1):24515. doi: https://doi.org/10.1038/s41598-024-76503-w
Wagner K, Reinhardt Z, Negash S, Weber L, Wienke A, Mikolajczyk R, et al. University students’ health-related quality of life and its determinants. Results from a cross-sectional survey during the COVID-19 pandemic. PloS one. 2025;20(1):e0310378. doi: https:// doi.org/10.1371/journal.pone.0310378
Son C, Hegde S, Smith A, Wang X, Sasangohar F. Effects of COVID-19 on college students’ mental health in the United States: Interview survey study. J Med Internet Res. 2020;22(9):e21279. doi: 10.2196/21279
Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental health status among children in home confinement during the coronavirus disease 2019 outbreak in Hubei Province, China. JAMA pediatrics. 2020;174(9):898-900. doi:10.1001/jamapediatrics.2020.1619
Adams KL, Saunders KE, Keown-Stoneman CDG, Duffy AC. Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study. BMJ open. 2021;11(12):e047393. doi: 10.1136/bmjopen-2020-047393
Asrie AB, Dereje M, Getachew A, Genetu B. Assessment of Health‐Related Quality of Life and Its Associated Factors Among Cardiovascular Disease Patients at a Teaching Hospital in Northwest Ethiopia: A Cross‐Sectional Study. BioMed Res Int. 2025;2025:1159456. doi: https://doi.org/10.1155/bmri/ 1159456
Palacios-Cartagena RP, Adsuar JC, Hernández-Mocholí MÁ, Carlos-Vivas J, Barrios-Fernández S, Garcia-Gordillo MA, et al. Health-related quality of life norm data of the Peruvian adolescents: results using the eq-5d-y. Int J Environ Res Public Health. 2021;18(16):8735. doi: https://doi.org/ 10.3390/ijerph18168735
Tan GXD, Soh XC, Hartanto A, Goh AYH, Majeed NM. Prevalence of anxiety in college and university students: An umbrella review. J Affect Disord Rep. 2023;14:100658. doi: https://doi.org/10.1016/j.jadr.2023.100658
Li H-M, Zhong B-L. Quality of life among college students and its associated factors: a narrative review. AME Med J. 2022;7. doi: 10.21037/ amj-22-96
Ifroh RH, Gai X, Rabiautsani MA, Han X. The social support, healthy lifestyle, subjective well-being, and health-related quality of life among university students. J Educ Health Promot. 2024;13(1):427. doi: 10.4103/jehp. jehp_1988_23
Baalmann T. Health-Related Quality of Life, Success Probability and Students’ Dropout Intentions: Evidence from a German Longitudinal Study. Res High Educ. 2024;65:153-80. doi: https:// doi.org/10.1007/s11162-023-09738-7
Torkani F, Ahmadi S-H, Binazir A, Fath MM, Shafigh N, Asadiparvar-Masouleh H, et al. The relationship between health-related quality of life and academic success in nursing students: the mediating role of academic burnout and academic motivation. BMC Med Educ. 2025;25:42. doi: https://doi.org/ 10.1186/s12909-025-06661-6
