5 JNK JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk Early Detection of Mental Disorders and Psychosocial Problems in Students Taking Online Learning during COVID-19 Pandemic Sirli Mardianan Trishinta1, Wahidyanti Rahayu Hastutiningtyas2, Yanti Rosdiana3 1,2Nursing Department, Tribhuwana Tunggadewi University Malang, Indonesia Article Information Abstract The online problems impact from online learning faced by students if not handled immediately will lead to the impact of mental disorders and psychosocial problems that are bigger and more serious. The aim of this study was to conduct early detection of mental disorders and psychosocial problems in nursing students who take online clinical practices during the COVID-19 pandemic at Tribhuwana Tunggadewi University, Malang. This was descriptive research with a cross-sectional approach. That is, data between the independent and dependent variables collected at the same time. The population in this study was all students at Tribhuwana Tunggadewi University Malang, class of 2016, as many as 276 people. The sampling technique used total sampling technique. This study used Chi square analytics to test the hypothesis. ThWe result of this study showed that gender was significantly associated with psychological problems (p = 0.038), while gender had no correlation with the use of psychoactive use (p = 0.789), and PTSD (p = 0.551). It concluded that mental disorders and psychosocial problems (i.e., psychological problem, psychoactive use, PTSD and unidentified psychologicaly) were prevalent among nursing students who took online clinical practice at Tribhuwana Tunggadewi. Students’ gender was associated with psychological problems, while had no associated with psychoactive use and PTSD. This study recommends that faculty authority, health professionals, and other professional related to mental health should play an important role for the prevention and earlier recognition of and intervention for psychosocial problems in nursing students who run online clinical practice during the COVID-19 pandemic. History Article: Received, 10/22/2021 Accepted, 09/03/2022 Published, 15/04/2022 Keywords: pandemic, online learning, nursing study © 2022 Journal of Ners and Midwifery Correspondence Address: Tribhuwana Tunggadewi University Malang – East Java, Indonesia P-ISSN : 2355-052X Email: sirli.shinta@unitri.ac.id E-ISSN : 2548-3811 DOI: 10.26699/jnk.v9i1.ART.p005-011 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) http://jnk.phb.ac.id/index.php/jnk mailto:sirli.shinta@unitri.ac.id https://doi.org/10.26699/jnk.v9i1.ART.p005-011 6 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 5-11 INTRODUCTION Students are students in an institution, both public and private, who are currently studying. Students are people who are officially registered and accepted to take part in the learning process at a university with the age of 17-30 years. Students are people who study in tertiary institutions, both universities and institutions or academics, individuals who are register as students in higher education (Takwin, 2008). Students are classified as late teens aged 17-25 years (Depkes RI, 2009) . The COVID-19 pandemic has greatly affected all aspects of life also has an impact on the world of education. With the issuance of the circular letter of the Minister of Education and Culture Number 36962/MPK.A/HK/2020, it is stated that all teaching and learning activities both at school and on college campuses use online or online as an effort to prevent the development and spread of Coronavirus disease (COVID-19) (Kemendikbud RI, 2020). The most felt impact is the change in the teaching and learning process in the world of education, which face-to-face before and replaced by online. This incident can cause new problems, namely mental disorders and psychosocial disorders. Research conducted by Uswatun et al (2020) shows that there are many disturbances, ranging from disruption of education. There are students who are confused in dealing with online learning methods, plus the number of tasks that cause the widespread concern and anxiety of students in the midst of the COVID-19 pandemic. Learning assignments are the main factor causing student stress during the COVID-19 pandemic (Hasanah et al., 2020). Anxiety can be in the form of feelings of worry, feeling uneasy, uncertain or feeling very afraid as a result of a threat or threatening feelings where the real source of the anxiety is not known with certainty (Nasir & Muhith, 2011). This anxiety is one of the symptoms of mental disorders and psychosocial problems. Mental disorder or mental disorder is a condition that is felt and able to affect a person's thoughts, moods and behavior. Mental health problems that arise in the midst of the COVID-19 pandemic can develop into long-lasting health problems and have the potential to cause a heavy social burden. People with psychiatric problems are people who have physical, mental, social, growth and development problems, and or quality of life at risk of experiencing mental disorders (Kementrian Kesehatan RI, 2019). Psychosocial problems are problems that arise as result of many changes in the order of the environment. Psychosocial is a condition that occurs in individuals that includes psychological and social aspects or vice versa (Maulana et al., 2019). The number of people with mental disorders in the world continues to increase every year. According to WHO data (2016), there are about 35 million people affected by depression, 60 million people affected by bipolar disorder, 21 million people affected by schizophrenia, and 47.5 million people affected by dementia. According to the National Alliance of Mental Illness (NAMI) based on the results of the 2013 United States population census, it estimated that 61.5 million people over the age of 18 have mental disorders, 13.6 million of whom have severe mental disorders such as schizophrenia, bipolar disorder. Riskesdas 2018 data shows the prevalence of emotional mental disorders that indicated by symptoms of depression and anxiety for ages 15 years and over reaches around 6.1% of the total population of Indonesia. While in East Java the rate of emotional mental disorders is 6.8% (Balitbangkes, 2018). The problems faced by students if not handled immediately will lead to the impact of mental disorders and psychosocial problems that are bigger and more serious. The results of research conducted by Nurjanah (2020) showed that the most complaints were psychological complaints, namely feeling anxious, tense/worried (40%), followed by complaints of neglected daily activities/tasks (37%), loss of appetite (30%), and not sleeping well (30%) (Nurjanah, 2020). Another study conducted by Larasuci nd Setiadi (2020) found that the results of research on psychosocial problems that found sequentially from the highest to the lowest were Post Traumatic Distress Sydrom (PTSD). As many as 63 respondents (32%), anxiety and depressionas many as 55 respondents (28%), psychotic disorders as many as 42 respondents (21%), and psychoactive substances use, drugs as many as 8 respondents (4%), while as many as 29 respondents (15%) were not indicated to have psychosocial problems or disorders (Arini & Syarli, 2020). From the research above, it concludes that mental disorders and psychosocial problems can pose greater impact. Therefore, action is need to find out mental disorders and psychosocial problems more quickly, to avoid unwanted and life-threatening events by conducting early detection. Mental Disorders and Trishinta, Hastutiningtyas, Rosdiana, Early Detection of Mental Disorders and Psychosocial Problems … 7 Psychosocial Problems in Nursing Students Who Carry Out Clinical Practices Online During the COVID-19 Pandemic at Tribhuwana Tunggadewi University, Malang The results of a preliminary study conducted on 10 nursing students who underwent online clinical practice showed that students experienced fear, irritability, anxiety, sadness, discomfort and guilt. Based on this phenomenon, the researchers are interested in conducting study entitled "Early Detection of Mental Disorders and Psychosocial Problems in Nursing Students Who Run Online Clinical Practices During COVID-19 Pandemic at Tribhuwana Tunggadewi University, Malang" METHOD This study was descriptive research with a cross-sectional approach. That is, data between the independent and dependent variables collected at the same time. The population in this study was all students at Tribhuwana Tunggadewi University Malang, class of 2016, as many as 276 people. The sample used was 276 students at Tribhuwana Tunggadewi University, Malang. The sampling technique used total sampling technique. The independent variable in this study was early detection. The dependent variables in this study were mental disorders and psychosocial problems. This study was conducted at Tribhuwana Tunggadewi University, Malang city. Materials and Research Tools / Research Instruments This study used the SRQ (Self Reporting Questionnaire) questionnaire that contains 29 questions. On questions 1-20 experiencing psychological problems, number 21 the use of psychoactive substances, number 25-29 symptoms of post-traumatic distress syndrome (PTSD). The question has an answer of “yes” or “no” by cut off point system. It means that if respondent >6 answers “yes” to the question asked, the respondent has a mental disorder or has one of the complaints from questions 21-29, the answer is “yes” in number 21 is an indication of the use of psychoactive substances, and if you answer "yes" in numbers “25-29 it is a symptom of post- traumatic distress syndrome (PTSD). Data collection The data obtained in this study carried out by distributing online questionnaires. Data analysis The data collected through the SRQ-29 questionnairethen assessed according to existing standards. Analysis of the data obtained carried out descriptively using SPSS with Chi square analytics. RESULT General data of respondents in this study include gender, age, marriage status, family income, and nation. Table 1: Distribution of Gender, Age, Employment Status, Marital Status, Family Income, Ethnicity. No Characteristics n f 1 Gender Male 113 41 Female 163 59 Total 276 100 2 Age 18-22 year 181 66 23-27 Tyear 95 34 Total 276 100 3 Marriage status Married 276 100 Not married 0 0 Total 276 100 8 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 5-11 5 Family income <3 million rupiah 250 91 >3 million rupiah 26 9 Total 276 100 6 Nation Indonesia 262 95 Timor Leste 14 5 Total 276 100 Based on table 1, it shows that most of the students at Tribhuwana Tunggadewi University Malang who took online lectures during COVID- 19 pandemic were female (59%) most of them were 18-22 years old (66%), all of them are student (100%), all students have unmarried status (100%), almost all family income <3 million (91%), and almost all are Indonesians (95%). Table 2: Research Results on Early Detection of Mental Disorders and Psychosocial Problems No Classification F % 1. Psychological problem Yes No 97 179 35 65 2. Psychoactive use Yes No 4 272 1 99 3. PTSD (Post Trauma Stress Disorder) Syndrome Yes No 167 109 61 39 4. Unidentified psychological problems 8 3 Total 276 100 Based on table 2 shows that most respondents do not experience psychological problems (65%), almost all respondents have no problems with the use of psychoactive substances (99%), most respondents experience PTSD problems (61%), and a small proportion of respondents are not identified. interference (3%). Table 3: Test Results Analysis of Sex Correlations with psychological problems, use of psychoactive substances and PTSD Variable Gender p Female Male Psychological problem Yes No 66 97 32 81 0,038 Psychoactive use Yes No 2 160 1 111 0,789 PTSD (Post Trauma Stress Disorder) Syndrome Yes No 96 66 71 42 0,551 Table 3 shows that gender is significantly associated with psychological problems (p = 0.038), while gender has no correlation with the use of psychoactive substances (p = 0.789), and PTSD (p = 0.551). It concluded that mental disorders and psychosocial problems (i.e., psychological problem, psychoactive use, PTSD and unidentified psychologicaly) were prevalent Trishinta, Hastutiningtyas, Rosdiana, Early Detection of Mental Disorders and Psychosocial Problems … 9 among nursing students who run online clinical practice at Tribhuwana Tunggadewi. Students’ gender is associated with psychological problems, while has no associated with psychoactive use and PTSD. DISCUSSION Characteristics of respondents Based on table 1, most of the respondents (59%), female respondents, aged between 18-22 years, mostly (66%). This is in line with Handayani's research (2020) which states that in the online learning system during the COVID-19 pandemic era, most students from all faculties at Tribhuwana Tunggadewi University Malang took online/online lectures (Meri, 2020). The results of this study are in line with the research of Pathmanathan and Husada (2013), which states that based on age group, the majority of mental disorders are experienced by students aged 19 and 20 years (Pathmanathan & Husada, 2013). The theory that has been developed states that older people tend to feel negative effects due to the increasing causes of daily stress (O’Callaghan, 2014). However, age can also predict a person's way of solving a problem. The more mature a person is, the better their ability to make changes in attitudes, cognitive, and emotions, in order to carry out coping strategies. In other words, students with an older age are able to perform better and more diverse problem solving strategies than people who are younger than them (Monteiro et al., 2014) Psychosocial problems in students in carrying out online lectures Based on table 2 shows most (65%), respondents do not experience psychological problems. Based on Chaplin and Kartono (2019), individual psychosocial behavior based by the attitudes that arise from psychological and social symptoms, which influence each other (Chaplin & Kartono, 2019). Psychosocial is an aspect of dynamic correlation between psychological and social dimensions. Suffering and psychological injuries experienced by individuals have a close correlation with the surrounding circumstances or social conditions. Psychosocial recovery for individuals and community groups aimed at regaining normal functions so that they remain productive and lead a meaningful life after a traumatic event (Iskandar, 2005). Factors that cause psychosocial problems in students during the COVID-19 pandemic can caused by many things, one of which is the COVID-19 pandemic condition that requires all learning processes to be carried out through an online learning system. This learning system requires students to carry out the learning process from home, with emotional support and optimal supervision from the family, so that this can indirectly cause students' anxiety levels (Kumari et al., 2020). The considerably such prevalence of mental disorder and psychosocial problems among nursing students who take online learning during COVID-19 pandemic suggests the vulnerability of faculty in students. Therefore, these findings indicate a need for advanced survey and launch awareness programme for preventing mental disorder and psychosocial problems. Correlation of sex with psychological problems Based on table 3 the analysis test showed that gender was significantly associated with psychological problems (p=0.038), while gender had no correlation with the use of psychoactive substances (p=0.789), and PTSD (p=0.551). The difference in the prevalence of psychological problems in male and female students is in line with research by Rahmayani (2017), on students of the Andalas University Faculty of Medicine, which stated that, by gender, first-year medical students were female (69 ,6%) had a higher level of psychological problems than men (30,4%) (Rahmayani et al., 2019). Then, this is also in line with research by Eva et al. (2015), at a private university in Bangladesh, who stated that second and third year medical students, who were female (64%), had a higher prevalence of psychological levels than men (36%) (Eva et al., 2015). Research limitations The limitation of this study is that it does not consider other factors that may influence psychosocial behavior in students, such as the description of stress levels in the online learning system in the era of the COVID-19 pandemic. 10 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 5-11 CONCLUSION Most of the students at Tribhuwana Tunggadewi University Malang who took online lectures during the COVID-19 pandemic was female (59%), and most was aged 18-22 (66%) The results had shown that most of the respondents did not experience psychological problems (65%), almost all of the respondents had no problems with the use of psychoactive substances (99%), most of responden experienced PTSD problems (61%), and a small portion of the respondents had no identified disorders (3%). The results obtained shown that gender significantly associated with psychological problems (p = 0.038), while gender had no correlation with the use of psychoactive substances (p = 0.789), and PTSD (p = 0.551). SUGGESTION The results of this study are expected to applied by public as information and learning guidelines to add insight and information regarding early detection of mental disorders and psychosocial problems in nursing students who run online clinical practice during the COVID-19 pandemic. This study recommends that faculty authority, health professionals, and other professional related to mental health should play an important role for the prevention and earlier recognition of and intervention for psychosocial problems are expected to be used as learning literature and a source of information about early detection of mental disorders and psychosocial problems in nursing students who run online clinical practice during the COVID-19 pandemic. ACKNOWLEDGMENT We would like to thank all the nursing students who participated in the study. This project received funding from the Nursing Profession Program of Faculty of Health Science Tribhuwana Tunggadewi University. REFERENCE Arini, L., & Syarli, S. (2020). Deteksi Dini Gangguan Jiwa Dan Masalah Psikososial Dengan Menggunakan Self Reporting Qustioner (SRQ-29). Jurnal Keperawatan Muhammadiyah, 5(1). Balitbangkes, R. I. (2018). Laporan nasional Riset Kesehatan dasar (Riskesdas) tahun 2018. Jakarta: Balitbangkes RI. Chaplin, J. P., & Kartono, K. (2019). Kamus lengkap psikologi. Depkes RI. (2009). Profil kesehatan Indonesia 2008. Departemen Kesehatan Republik Indonesia. Eva, E. O., Islam, M. Z., Mosaddek, A. S. M., Rahman, M. F., Rozario, R. J., Iftekhar, A. F., Ahmed, T. S., Jahan, I., Abubakar, A. R., & Dali, W. P. E. W. (2015). Prevalence of stress among medical students: a comparative study between public and private medical schools in Bangladesh. BMC Research Notes, 8(1), 1–7. 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