


































Global Research in Higher Education 
ISSN 2576-196X (Print) ISSN 2576-1951 (Online) 

Vol. 5, No. 2, 2022 

www.scholink.org/ojs/index.php/grhe 

1 

 

Short Paper 

Campus Population Changes in Depression Severity Correlated 

with the COVID-19 Pandemic 

Agustina Marconi
1
, Bjorn Hanson

2
, Ellie Kachel

3
, Megan Crass

4
 & Elizabeth C Falk-Hanson

5
 

1
 University Health Services (UHS) Epidemiologist, University of Wisconsin-Madison, Madison, 

Wisconsin, USA 

2
 Coordinator of Quality, Data, and Informatics, Mental Health Services University Health Services 

(UHS), University of Wisconsin-Madison, Madison, Wisconsin, USA 

3
 Informatics University Health Services (UHS), University of Wisconsin-Madison 

4
 Medical Coordinator, University Health Services (UHS), University of Wisconsin-Madison, Madison, 

Wisconsin, USA 

5
 Nurse Practitioner, Women’s Health and Sexual Health Clinics, UW-Madison University Health 

Services 

 

Received: April 8, 2022        Accepted: April 26, 2022         Online Published: May 19, 2022 

doi:10.22158/grhe.v5n2p1                URL: http://dx.doi.org/10.22158/grhe.v5n2p1 

 

Abstract 

Introduction: Mental health consequences during COVID-19 Pandemic burdened societies. Objective: 

The aim is to assess the average PHQ-9 in medical visits during pandemic months and compare it with 

historical data, adapting an existing methodology. Methodology: we used average PHQ-9 score from 

medical departments, comparing 2020 Fall term data to historical baseline. The increase above 

baseline and threshold was reported as percentage. We compared the observed average for the current 

period with the expected average and the higher limit of the 95% confidence interval (CI 95%) derived 

from historical five years of data. Also, we analyzed the PHQ-9 difference between female and male 

students for the whole period. Results: Average PHQ-9 for total sample, females and males increased. 

Difference female- male in scoring was significant. Discussion: In line with national and international 

literature, our population showed increases in depressive scoring during pandemic months. Women 

had a higher percentage of increase. 

Keywords 

PHQ-9, Depression, Student Health Services, COVID-19 

 

 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

2 
Published by SCHOLINK INC. 

 

1. Introduction 

The severe respiratory syndrome caused by the novel coronavirus (SARS CoV-2) is described as the 

greatest global health crisis the world has faced since the influenza pandemic of the early twentieth 

century (El Zowalaty & Järhult, 2020). From early stages of this global emergency, it became evident 

that the mental health consequences that this pandemic caused would burden societies (Torales, 

Higgins, Castaldelli-maia & Ventriglio, 2020). Around the world there have been mental health 

assessments for healthcare workers and for the general population during the lockdown months and 

afterwards. In the UK, and for the general population, the prevalence of depressive, anxiety, and 

insomnia symptoms significantly increased relative to pre pandemic levels based on epidemiological 

data (Pieh, Budimir, Delgadillo, Barkham, Fontaine & Probst, 2021). The “Understanding America 

Study” (UAS) showed that in March 2020 around 29% of the US adult population reported 

deterioration in depression and anxiety symptoms (Kämpfen, Kohler, Ciancio, Bruine de Bruin, Maurer 

& Kohler, 2020). 

College Mental Health 

College years can be distressing during non-pandemic times. The new environment and the study 

requirements is stressful for most students. In 2018, the National College Health Assessment (NCHA) 

from American College Health Association (ACHA) data showed 17.1% of undergraduate students felt 

depressed and 18.1% felt overwhelming anxiety in the last 12 months (American College Health 

Association, 2018). 

When assessing college students’ mental health during pandemic months, literature shows almost 50% 

of the students reported a moderate-to-severe level of depression, 38.48% reported a 

moderate-to-severe level of anxiety, and around 18.04% had suicidal thoughts. Over 70% of the 

students indicated that their stress/anxiety levels had increased during the pandemic (Wang, Hegde, 

Son, Keller, Smith & Sasangohar, 2020). 

The University of Wisconsin-Madison (UW-Madison) is a large public research university in the 

Midwest United States with a total fall 2020 enrollment of 45,540. There are 13 schools and colleges 

offering multiple undergraduate, master’s, and doctoral degree programs (University of 

Wisconsin-Madison, n.d.). In 2020, 69.5% of enrolled students were undergraduates, 52.2% were female, 

12.9% were international students, and 65% were white (UW-Madison Data Digest, 2021). University 

Health Services (UHS) is the medical service that offers primary care, sexual health and mental health 

services for enrolled students. In the past, UHS has focused their research on mental health issues such as 

“complete response rates” for PHQ-9 for UW- Madison students (Marconi, Ranum, Orman, Hanson, 

Donovan & Borenitsch, 2019).  

 

 

 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

3 
Published by SCHOLINK INC. 

 

2. Participants and Settings 

2.1 Setting 

The University Health Services (UHS) is a primary care setting that assists medical and mental health 

needs of UW-Madison students. Historically, the medical services unit of UHS completed between 

75000 and 95000 visits per fiscal year (University Health Services (UHS), n.d.). 

2.2 Data 

Data includes average PHQ-9 per week during Fall Semester (8/30/2020-1/2/2021).  

PHQ-9 surveys are launched in response to a positive PHQ-2 score, with the threshold for PHQ-2 score 

set at 3 or above. Prior to 2020 this procedure was manual, and it was completed by the medical 

assistants during the patient rooming process. Since January 2020 the process was automated through a 

new self-check-in process linked to the electronic health record. The PHQ-2 is administered as part of a 

health screening survey every 90 days. No PHI was utilized for this analysis. 

2.3 Definitions 

PHQ-9: The Patient’s Health Questionnaire (PHQ-9) is a nine-item depression scale of the Patient 

Health Questionnaire (PHQ). It is a validated instrument utilized around the world by primary care 

health workers to screen for the presence and severity of depression (modeled after DSM-IV criteria). It 

is also used to monitor treatment response (University of Washington, Psychiatry & Behavioral 

Sciences Division of Population Health, n.d.). The PHQ-9 scale has been widely used and has proved 

to be reliable to detect depression (Sun, Fu, Bo, et al., 2020; Kroenke, Spitzer & Williams, 2001).  

The aim of this study is to assess the average PHQ-9 in medical visits during pandemic months and 

compare it with historical data, adapting an existing methodology (Vital Strategies, World Health 

Organization, 2020). 

 

3. Methods 

We developed an exploratory analysis of the increase in “average PHQ-9” for medical visits during 

Fall Term 2020 (9/6/2020- 12/26/2020) and its comparison with same period historical data (Fall terms 

2015-2019) in college students at UHS, UW-Madison. For the design and statistical comparison, we 

adapted the World Health Organization (WHO) recommendations for rapid mortality surveillance and 

epidemic response for a morbidity screening tool, like PHQ-9. For the analysis we used average PHQ-9 

score total and per week, comparing 2020 Fall term data to the historical baseline (i.e., The same period 

in the past 5 years). We reported PHQ-9 as the average of all scores collected by medical departments 

per week. The increase above baseline and threshold was reported as percentage. We compared the 

observed average for the current period with the average expected and the higher limit of the 95% 

confidence interval (CI 95%) derived from historical five years of data. If a certain week in 2020 had 3 

or less registers, we took a conservative approach and assumed the lower historical value. An 

Institutional Board (IRB) approved the protocol. 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

4 
Published by SCHOLINK INC. 

 

We then analyzed the increase “average PHQ-9” for the total period for female and male students. 

Finally, we analyzed the PHQ-9 difference between female and male students for the whole period. We 

determined the observed average PHQ-9 for both groups, the expected average PHQ-9 for both groups 

and then we determined the PHQ-9 difference between female and male. We define the PHQ-9 

difference as the subtraction of the average PHQ-9 for female- PHQ-9 for male for the total period. 

 

4. Results 

Table 1 and Chart 1 show the analyzed data for the total period and per week and totals by sex. 

Average PHQ-9 for the entire semester in 2020 was 13.8, whereas historical average PHQ-9 was 11.3. 

The excess of average PHQ-9 for the whole Fall term compared to 2015-2019 was 21.4% with a 

significant increase when compared to the historical upper Confidence Interval 95% (14.7%). In the 

weekly analysis we observed a significant increase of the average PHQ-9 in all the weeks but F1 

(9/12/2020), F8, F9 and F10 (10/31/2020-11/14/2020). Specifically, F2 (9/19/2020) had a significant 

increase above 50% of baseline. On the other hand, none of the weeks had a significant decrease in the 

average PHQ-9 compared to historical. 

Average PHQ-9 for female students in the whole Fall period 2020 was 14.1, whereas historical average 

was 11.5. The excess of average PHQ-9 for the whole period compared to 2015-2019 was 21.9% with a 

significant increase when compared to the historical upper Confidence Interval 95% (14.8%). Average 

for male students in the whole Fall 2020 period was 12.4, whereas historical average was 10.9. The 

excess of average PHQ-9 for the whole period compared to 2015-2019 was 13.9% with a significant 

increase when compared to the historical upper Confidence Interval 95% (7%).  

Finally, we observed a Fall 2020 female- male difference of 1.6 with a historical 0.6. This means a 

significant percentage above baseline of 167.6% and above historical upper Confidence Interval 95% 

of 54.4%. 

 

 

 

 

 

 

 

 

 

 

 

 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

5 
Published by SCHOLINK INC. 

 

Table 1. Excess of Average PHQ-9 College Students and Historical Comparison. Total and per 

Fall term weeks and total per sex. UHS, UW-Madison Fall Term 2020 (September to December 

2020) 

Fall Week (ending week for 2020) 

2015-2019 

Weekly average 

(95% CI) 

2020 PHQ9 

Average 

% Above 

baseline 

% Above 

threshold 

F1 (9/12/2020) 11.6 (9.2- 14) 12.3 6.0 -12.2 

F2 (9/19/2020) 10.4 (8.5-12.4) 16.1 54.2 29.6 

F3 (9/23/2020) 10.2 (8.9-11.5) 14.0 37.3 22.2 

F4 (10/3/2020) 11.3 (10.5- 12.1) 14.0 23.7 15.6 

F5 (10/10/2020) 11.1 (10.1-12.2) 14.6 31.1 19.7 

F6 (10/17/2020) 11.5 (10.3-12.7) 12.8 10.9 0.5 

F7 (10/24/2020) 11.8 (10.5- 13.2) 13.5 14.2 2.6 

F8 (10/31/2020) 12.2 (11.6-12.9) 12.2 -0.3 -5.2 

F9 (11/7/2020) 11.5 (10.1-12.9) 12.7 10.2 -1.7 

F10 (11/14/2020) 11.9 (10.5-13.3) 13.1 10.1 -1.7 

F11 (11/21/2020) 10.7 (9.7-11.7) 14.6 36.4 24.3 

F12 (11/28/2020) 11.9 (11.3-12.4) 14.3 20.6 15.3 

F13 (12/5/2020) 11.5 (10.3- 12.7) 14.4 25.7 13.7 

F14 (12/12/2020) 11.2 (10.1-12.2) 13.9 24.6 14.2 

F15 (12/19/2020) 11.6 (11.0-12.2) 13.5 16.4 10.4 

F16 (12/26/2020) 10.9 (9.9-11.9) 14.3 31.0 20.1 

Total 11.3 (10.7-12.0) 13.8 21.4 14.7 

Total Female 11.5 (10.8-12.3) 14.1 21.9 14.8 

Total Male 10.9 (10.2-11.6) 12.4 13.9 7.0 

Difference Female- Male 0.6 (0.16-1.05) 1.6 167.6 54.4 

 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

6 
Published by SCHOLINK INC. 

 

 

Figure 1. Average PHQ9 Fall Term 2020-2021 by Week Compared to the Upper and Lower 

Limits of Historical Data Fall Terms 2015-2019 (95% CI) 

 

5. Discussion 

We were able to adapt an existing methodology meant to check for excess of mortality during a global 

health crisis to measure the increase of PHQ-9 average score in a college population. 

Our study shows a significant increase of the average PHQ-9 compared to historical data for the entire 

sample. In line with national and international literature, our population showed increase in depressive 

scoring during the pandemic (Huckins, daSilva, Wang, Hedlund, Rogers, Nepal, Holtzheimer, 2020).  

Czeisler et al. reported a prevalence of depressive disorder in the general population in 2020, measured 

with PHQ-2, four times higher than what was reported in the second quarter of 2019. In the age group 

18-24 the same authors report an increase in prevalence of depressive symptoms of over 50% (Czeisler, 

Lane, Petrosky et al., 2020). Also, when comparing pre- and during-pandemic mental health status in 

adults in the US, prevalence of depression symptoms was more than 3-fold higher during COVID-19 

compared with before the COVID-19 pandemic (Ettman, Abdalla, Cohen, Sampson, Vivier & Galea, 

2020). When referring specifically to the college population, literature highlights college students were 

more sedentary, anxious, and depressed (Jia, Ayling, Chalder, Massey, Broadbent, Coupland et al., 

2020). It is also widely described how mental health issues disproportionately impacted females to a 

greater degree during the pandemic (Xiong, Lipsitz, Nasri, Lui, Gill, Phan et al., 2020).  

In our study, although both females and males had significant increases in average PHQ9, it is women 

that had a higher percentage of increase from historical data. While it is beyond the scope of this 

analysis, this could be related to women reporting more pandemic-related distress than men (Yan et al., 

2021).  

 

 



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

7 
Published by SCHOLINK INC. 

 

Not only did we observe a significant increase in the average PHQ-9 for the total period for both 

females and male, but we also saw a significant increase in the PHQ-9 difference between sexes, with 

female students seeing a sharper increase in PHQ-9 score.  

 

6. Limitations 

Due to changes in PHQ9 data collection unrelated to Pandemic, we were only able to assess the Fall 

term and not Spring or Summer terms of 2020. Due to sample size, we could not check for sex per 

week or for age groups, race groups, gender minorities or any academic variable. 

 

References 

American College Health Association. (2018). National College Health Assessment. Undergraduate 

student Reference Group. Data Report, Fall 2018. Retrieved from 

https://www.acha.org/documents/ncha/NCHA-II_Fall_2018_Undergraduate_Reference_Group_D

ata_Report.pdf 

Czeisler, M. É., Lane, R. I., Petrosky, E. et al. (2020). Mental Health, Substance Use, and Suicidal 

Ideation during the COVID-19 Pandemic-United States, June 24-30, 2020. MMWR Morb Mortal 

Wkly Rep., 69(32), 1049-1057.  

El Zowalaty, M. E., & Järhult, J. D. (2020). From SARS to COVID-19: A previously unknown 

SARS-related coronavirus (SARS-CoV-2) of pandemic potential infecting humans–Call for a One 

Health approach. One Health, 9, 100124. 

Ettman, C. K., Abdalla, S. M., Cohen, G. H., Sampson, L., Vivier, P. M., & Galea, S. (2020). Prevalence 

of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw 

Open, 3(9), e2019686.  

Huckins, J. F., daSilva, A. W., Wang, W., Hedlund, E., Rogers, C., Nepal, S. K., … Holtzheimer, P. E. 

(2020). Campbell AT Mental Health and Behavior of College Students During the Early Phases of 

the COVID-19 Pandemic: Longitudinal Smartphone and Ecological Momentary Assessment Study. 

J Med Internet Res., 22(6), e20185  

Jia, R., Ayling, K., Chalder, T., Massey, A., Broadbent, E., Coupland, C, et al. (2020). Mental health in 

the UK during the COVID-19 pandemic: Cross-sectional analyses from a community cohort study. 

BMJ Open, 10(9), e040620 

Kämpfen, F., Kohler, I. V., Ciancio, A., Bruine de Bruin, W., Maurer, J., & Kohler, H. P. (2020). 

Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, 

health worries and social distancing. PloS one, 15(11), e0241895. 

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity 

measure. J Gen Intern Med., 16(9), 606-613.  



www.scholink.org/ojs/index.php/grhe            Global Research in Higher Education                  Vol. 5, No. 2, 2022 

8 
Published by SCHOLINK INC. 

 

Marconi, A., Ranum, N., Orman, S. V., Hanson, B., Donovan, V., & Borenitsch, E. (2019). Demographic 

differences in response rates for PHQ9 in a university student population. Journal of American 

College Health, 67(3), 283-289. 

Pieh, C., Budimir, S., Delgadillo, J., Barkham, M., Fontaine, J. R. J., & Probst, T. (2021). Mental Health 

During COVID-19 Lockdown in the United Kingdom. Psychosomatic Medicine, 83(4), 328-337. 

Sun, Y., Fu, Z., Bo, Q. et al. (2020). The reliability and validity of PHQ-9 in patients with major 

depressive disorder in psychiatric hospital. BMC Psychiatry, 20. 

https://doi.org/10.1186/s12888-020-02885-6 

Torales, J., Higgins, M. O., Castaldelli-maia, J. M., & Ventriglio, A. (2020). The outbreak of 

COVID-19 coronavirus and its impact on global mental health. International Journal of Social 

Psychiatry.  

University Health Services (UHS). (n.d.). Annual Report 2018-2019. Retrieved from 

https://www.uhs.wisc.edu/wp-content/uploads/2020/01/UHS_2019_AR_WEB_lores-1.pdf 

University of Washington, Psychiatry & Behavioral Sciences Division of Population Health. (n.d.). 

Advancing Integrated Mental Health Solutions. AIMS CENTER. Retrieved from 

https://aims.uw.edu/resource-library/phq-9-depression-scale 

University of Wisconsin-Madison. (n.d.). About UW. Retrieved from https://www.wisc.edu/about/ 

University of Wisconsin-Madison (2020-2021). Data Digest. Academic Planning and Institutional 

Research, Office of the Provost. Vice-Chancellor for Finance and Administrator. Retrieved March 

2017, from https://apir.wisc.edu/data-digest/ 

Vital Strategies, World Health Organization. (2020). Revealing the Toll of COVID-19: A Technical 

Package for Rapid Mortality Surveillance and Epidemic Response. New York: Vital Strategies. 

Wang, X., Hegde, S., Son, C., Keller, B., Smith, A., & Sasangohar, F. (2020). Investigating Mental 

Health of US College Students During the COVID-19 Pandemic: Cross-Sectional Survey Study. J 

Med Internet Res., 22(9), e22817.  

Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L. et al. (2020). Impact of COVID-19 

pandemic on mental health in the general population: A systematic review. Journal of Affective 

Disorders, 277, 55-64. 

Yan, S., Xu, R., Stratton, T. D., Kavcic, V., Luo, D., Hou, F. et al. (2021). Sex differences and 

psychological stress: Responses to the COVID-19 pandemic in China. BMC Public Health, 21(1), 

79.  

 


