Impact of COVID-19 on health-related quality of life in students and PhD students: a systematic review

Impact of COVID-19 on health-related quality of life in students and PhD students: a systematic review Nasie Asipova1, Sava Ognyanov2, Emanuil Yordanov2, Kostadin Angelov3, Emil Hristov2, Monika Komitova4, Valentina Petkova4, Stefka Stoyanova2, Iva Parvova5 1 National Health Insurance Fund, 1 Krichim str., Sofia 1407, Bulgaria 2 Laboratory of Social Pharmacy, Faculty of Chemistry and Pharmacy, Sofia University “Saint Kliment Ohridski”, 1 James Bourchier blvd., Sofia 1164, Bulgaria 3 Department of Surgery, Alexandrovska University Hospital, Medical University of Sofia, 1, St. G. Sofiyski str., Sofia 1431, Bulgaria 4 Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, 2 Dunav str., Sofia 1000, Bulgaria 5 Department of Rheumatology, Medical University of Sofia, 1 Dimitar Mollov str., Sofia 1704, Bulgaria Corresponding author: Valentina Petkova (vpetko[email protected]) Received 18 October 2025♦ Accepted 3 November 2025♦ Published 24 November 2025 Citation: Asipova N, Ognyanov S, Yordanov E, Angelov K, Hristov E, Komitova M, Petkova V, Stoyanova S, Parvova I (2025) Impact of COVID-19 on health-related quality of life in students and PhD students: a systematic review. Pharmacia 72: 1–12. https://doi. org/10.3897/pharmacia.72.e175314 Abstract Historically, epidemics have always posed a global threat to humanity not only in terms of health and its domains – physical, social, and psychological – but also in all spheres of human existence, including the economic, social, political, ethnocultural, and religious. Regardless of their cause or route of spread, the measures taken to limit the epidemics that have occurred have always aimed to restrict human activities in different ways and to varying degrees. The aim of this study is to determine the impact of anti-epidemic measures against the COVID-19 pandemic on health-related quality of life in a target group – students and PhD students. Materials and methods: We conducted a systematic review of scientific publications in journals referenced and indexed in world-renowned databases using keywords – a total of 90. We applied the criteria system of the PICOS tool to assess outcomes. Results and discussion: We found a high frequency of anxiety, depressive symptoms, stress, insomnia, and reduced quality of life in the observed population of 13,704 students and PhD students. The negative impact of the pandemic on the mental health and quality of life of students and PhD students is complex and multifactorial. The importance of the university environment, not only as an academic space but also as a social and health space, can play a key role in building resilience among young people in future crisis situations. Keywords COVID-19, depression, doctoral students, health-related quality of life, health status, mental health, quality of life, SARS-CoV-2, students Copyright Asipova N et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Pharmacia 72: 1–12 DOI 10.3897/pharmacia.72.e175314 Research Article Asipova N et al.: Impact of COVID-19 on health-related quality of life2 Introduction Historically, epidemics and pandemics have always represented a global threat to humanity in general and in particular, not only in terms of health and its domains – physical, social, and psychological – but also in all spheres of human existence – economic, social, political, ethnocultural, and religious. Despite significant progress in medicine and public health since the 19th century, humanity continues to face devastating epidemics and pandemics (Bonita et al. 2006; Huremović 2019; Sampath et al. 2021). The first cholera pandemic began in India in 1817. A total of six pandemics caused by Vibrio cholerae through contaminated water spread by 1923, and the seventh, which began in 1961 in Indonesia, is believed to still be ongoing (Huremović 2019). The Spanish flu pandemic of 1918, caused by the H1N1 strain, was the first true global pandemic to ravage the world and the first to occur within the framework of modern medicine. It claimed the lives of over 50 million people, forever changing modern medicine and epidemiology (Bonita et al. 2006). The scientific literature also provides sufficient and well-systematized data on other types of pandemics. HIV/AIDS is a slowly progressive global pandemic that began in the early 1980s and was initially marked by high mortality and strong social stigma. HIV affects about 40 million people worldwide and has killed almost the same number of people since 1981. Smallpox, a highly contagious disease with a high mortality rate, was the first disease for which a vaccine was developed in 1798 and, thanks to a coordinated global effort, was eradicated by the end of the 20th century – one of the greatest successes in the history of public health. The 2009 H1N1 pandemic, known as “swine flu,” was one of the first pandemics to include mental health aspects in policy reports on preparedness and mitigation (Huremović 2019; Sampath et al. 2021). The Ebola virus emerged in Central and West Africa, first identified in 1976, and, in 2013, caused significant outbreaks with over 28,000 cases and over 11,000 deaths (Sampath et al. 2021). Zika virus infection, recorded in Micronesia in 2007 and in Brazil in 2015, can cause Guillain-Barré syndrome in adults and severe microcephaly in unborn children of infected mothers (Huremović 2019; Sampath et al. 2021). The first coronavirus severe acute respiratory syndrome (SARS-CoV) originated in bats and was transmitted to humans via cats, causing severe acute respiratory syndrome (SARS) in humans in 2003; however, no human cases have been reported since 2004. The study of SARS provides valuable information about the mental health of affected individuals, families, and entire communities, including the mental health issues faced by health professionals (WHO 2022). The first transmission of the Middle East respiratory syndrome coronavirus (MERSCoV) was observed in 2012, transmitted from camels to humans, causing MERS, with infections largely confined to the Arabian Peninsula (Bonita et al. 2006; Huremović 2019; Sampath et al. 2021; WHO 2022). COVID-19, caused by SARS-CoV-2, emerged in late 2019 and spread rapidly around the world. Because SARS-CoV-2 is a novel virus and most people have no immunity to it, the entire human population was considered potentially susceptible to infection. In the first 2 years of the COVID-19 pandemic, more than 450 million cases were reported worldwide – more than 100 million in the European Union (EU) and European Economic Area (EEA). Because some infected individuals may be asymptomatic and not all symptomatic individuals are tested, it is estimated that the number of undiagnosed cases is much higher (WHO 2022). Regardless of their cause and route of spread, the measures taken to limit the epidemics that have occurred have historically always aimed to restrict human activities in different ways and to varying degrees. Anti-epidemic measures for airborne infections are based on the basic principles of epidemiology and are managed globally by the World Health Organization (WHO), national health authorities, and competent institutions. The measures aim to limit the spread of pathogens transmitted by airborne droplets and include isolation of the sick, quarantine, social distancing, wearing protective masks, hand hygiene, ventilation in indoor areas, disinfection of surfaces, vaccination, and early diagnosis (WHO 2020). In the 20th century, anti-epidemic measures evolved significantly thanks to advances in science and medicine. At the beginning of the century, before the discovery of antibiotics and vaccines for many diseases, measures mainly focused on hygiene, isolation, and limiting the spread. Toward the end of the century, with the advent of vaccines and a better understanding of pathogens, the focus shifted to mass immunization, development of antiviral drugs, prevention and population education, international coordination, and standards for disease control. During COVID-19, the WHO, the EU, and the United States recommended adherence to the basic principles of epidemiology, such as distancing, isolation, quarantine, and restriction of social and economic activities. China implemented a total closure of its borders and complete isolation. The Bulgarian health authorities referred to the recommendations of both the WHO and the EU, and on March 13, 2020, a state of emergency was declared as a measure to limit the spread of the coronavirus. As a result of the declared epidemic situation, several measures were imposed, such as wearing personal protective equipment, maintaining social distance, self-isolation, quarantining contact and infected citizens, and suspending visits to commercial establishments and other venues where people gathered. Classes and all extracurricular activities were suspended, and educational and almost all work processes moved to an electronic environment. The leading anti-epidemic measures can be systematized in several directions – isolation, quarantine, and treatment. Aim of the study To study the impact of anti-epidemic measures against the COVID-19 pandemic on the quality of life, and in particular, the health-related quality of life in a target group – students and doctoral students. To identify the conse- Pharmacia 72: 1–12 3 quences of the pandemic affecting the social life, feelings, satisfaction, and perceptions of the affected individuals. We chose the target group in this way because, for many young people, being a student is a dream come true and a source of pride. On the other hand, it is the desire of parents for their children to be highly educated and to be provided with the opportunity, regardless of their financial situation, to receive an education of the highest degree. The period of study covers a special stage of human development – the age between 18 and 19 and 23 and 25 years. This is a time when young people fully mature in physical, psychological, and social aspects, acquire the rights of adult citizens, and are ambitious to realize themselves at all costs (Gergov et al. 2021). The COVID-19 pandemic turned the lives of young people in this age group upside down, regardless of their social status, material and financial security, or cultural, ethnic, and religious differences. Materials and methods We conducted a systematic review of scientific publications in accordance with the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. 2009; Hutton et al. 2015; Shamseer et al. 2016). Topic of the systematic review: Impact of COVID-19 on health-related quality of life in students and PhD students. Design: Retrospective observational study. Search strategy: We conducted a search for publications and reports published in scientific journals referenced and indexed in world-renowned scientific information databases by keywords. Search language – No language restrictions were applied. Databases – PubMed, Scopus, Web of Science, and Google Scholar. Keywords: COVID-19, depression, health-related quality of life, health status, healthy volunteers, pharmacy students, PhD students, quality of life, students. Study period: January 2020–December 2023. For the analyzed period of 4 years, we found 90 scientific publications. Evaluated results and inclusion criteria: We analyzed scientific publications that included at least one of the keywords. Inclusion criteria for scientific publications: The scientific article should examine the impact of COVID-19 on health-related quality of life; study participants should be students or PhD students. Data extraction: Two of the authors extracted data from the research articles that were determined to meet the inclusion criteria independently of each other. For the present study, the following data were extracted: first author’s surname, year of publication, country of origin, type of scientific communication, type of studies, designs, countries in which the studies were conducted, COVID-19, HRQoL, QoL, students, PhD students, etc. Statistical analyses: We used the open-source statistical software Jamovi and Microsoft Excel 2024. We performed descriptive analysis and analysis of variance on the data. Results are presented as absolute and relative frequencies using univariate and bivariate frequency distribution tables. We used the criteria system of the PICOS tool – Population, Intervention, Comparison, Outcomes, and Study design (Methley et al. 2014) – to assess outcomes. The PICO tool focuses on the population studied, the type of intervention, comparison, and assessment of outcomes, most commonly quantified, and is commonly used to identify components of clinical evidence for systematic reviews in evidence-based medicine and has been adopted by the Cochrane Collaboration (Higgins and Green 2013). In the modified version of PICOS, “S” refers to study design; thus, we limited the number of irrelevant research articles and also focused on certain qualitative indicators. Results and discussion The literature search was limited to articles published in English and Bulgarian. In the initial search, we found 90 scientific publications, reviewed all 90 titles and abstracts, and then analyzed the full texts of the articles. We excluded 70 articles because they did not contain the keyword “COVID-19” in their description. In the final stage, we excluded 3 articles because they did not contain information on the assessment of health-related quality of life in students or PhD students. As a result of the systematic review, we selected 17 scientific publications to refer to. The selection of scientific publications is presented in the following figure as a PRISMA flow diagram (Fig. 1). Table 1 presents the main characteristics of 17 studies assessing the impact of the COVID-19 pandemic on mental health, quality of life, and related behavioral factors among student populations from different countries. The total sample size included over 13,000 participants from Europe, North America, South America, the Middle East, and Asia, with most studies conducted using online survey methods and validated scales to assess mental health and quality of life (PHQ-9, GAD-7, SF-12, SF-36, WHOQOL-BREF, MSPSS, PSQI, etc.). Over 70% of the research was published in 2022, likely reflecting a peak in scientific interest after the first data from the pandemic had accumulated and universities had adapted to the new reality. A smaller number of publications appeared at the beginning of the pandemic (2020– 2021) and at a later stage (2023), when the topic was already partially exhausted (Table 2). Sixteen studies with available data suitable for sampling were included in the analysis (for one of the studies, no data on the number of participants were available). The average number of participants was 857 students (95% CI: 526–1187). The median was 630, indicating that half of the studies had fewer than 630 participants and the other half had more. The sample sizes varied considerably, from 56 to 2031 participants. The standard deviation was 619, highlighting the large variability between studies. The Shapiro–Wilk test (p = 0.120) did not indicate a significant deviation from normality; therefore, the distribution of sample sizes was approximately normal (Table 3). Asipova N et al.: Impact of COVID-19 on health-related quality of life4 Records identified through database search (n = 90) Records screened (n = 90) Full-text articles assessed for eligibility (n = 20) Studies included in the qualitative analysis (n = 17) Records excluded – COVID-19 not present (n = 70) Full-text articles excluded – students or PhD students not present (n = 3) Studies included in the quantitative analysis (n = 17) Identification Screening Eligibility Included Figure 1. Overview of the search process – PRISMA flow diagram. The data in Table 4 indicate that 2022 is the period in which scientific interest reached its peak, but this growth was not evenly distributed across countries. In the early phases of the 2020–2021 pandemic, publications were rather isolated and nationally limited, e.g., Greece, USA, Italy, and Spain. This reflects rapid, often single-center studies aimed at documenting the initial effects of the pandemic. In 2022, wider geographical participation was already visible – countries from different regions such as Europe, Asia, Latin America, and the Middle East were included. This demonstrates a consolidation of scientific interest and more structured research initiatives. The fact that in 2023 only one study was published – the USA – can be interpreted as a partial exhaustion of the topic or a redirection of the research focus to post-pandemic aspects. In 2020, the mental health, severity of depression, and anxiety of college students during the COVID-19 pandemic were investigated in the United States using the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) questionnaires (Wang et al. 2020). Respondents had concerns related to their academic and health status and their lifestyle. Of the 2,031 participants, 48.14% showed moderate to severe depression, 38.48% had moderate to severe anxiety, and 18.04% had suicidal thoughts, with most participants indicating that their stress and anxiety levels had increased during the pandemic. Pharmacia 72: 1–12 5 Table 1. PICOS synthesis of studies on the impact of COVID-19 on groups of students and PhD students. Population Intervention Comparison Outcomes Study design 2031 Online surveys (Patient Health Questionnaire-9 and General Anxiety Disorder-7) for depression and anxiety, and additional multiplechoice and open-ended questions regarding stressors and coping mechanisms specific to COVID-19. Differences by gender and classification of undergraduate and graduate students. Association between pandemic and increased levels of depression, anxiety, and suicidal thoughts. 48.14% showed a moderate-to-severe level of depression, 38.48% showed a moderate-to-severe level of anxiety, and 18.04% had suicidal thoughts. A majority of participants (71.26%) indicated that their stress/anxiety levels had increased during the pandemic. Less than half of the participants (43.25%) indicated that they were able to cope adequately with the stress related to the situation. Cross-sectional study (online survey) 1296 Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Students with better vs. worse quality of life during COVID-19. Family social support predicted COVID-19 QoL; there were significant gender differences in social support and QoL; and higher perceived support was linked with better QoL. Observational, cross-sectional study (online survey) 1765 Online 128-item questionnaire assessing mental health, QoL, and coping strategies. Associations between sociodemographic/ lockdown factors and mental health/QoL outcomes (e.g., gender, isolation, financial stress). High prevalence of anxiety (58.1%), depression (11.6%), traumatic symptoms (19.5% IES-R>33), and suicidal ideation (4.4%); poorer mental HRQoL compared to physical; female gender, isolation, and financial and exam stress linked with poorer outcomes. Observational, cross-sectional study (online survey) 381 Online surveys (Google Forms) assessing perception of landscape and importance of recreational areas during COVID-19. Students‘ perceptions before vs. during the pandemic. Increased importance of recreational areas; stronger appreciation of nature, scenic views, and therapeutic effects of landscape; recommendation for more diverse and accessible green areas. Observational, cross-sectional study (online survey) 556 Measurement of smartphone addiction (Italian scale, validated), academic procrastination, and quality of life. Differences by gender and educational stage; analysis of relationships between procrastination, QoL, and smartphone addiction. 37.4% addicted to smartphones; 7.7% high procrastination; 62.8% moderate procrastination. Smartphone addiction was positively correlated with procrastination and negatively with QoL. No significant gender/stage differences in addiction or QoL, but procrastination is higher in males and undergraduates. Observational, cross-sectional study (online survey) 500 Online WHOQOL-BREF questionnaire assessing quality of life. Differences in quality of life by field of study and medical knowledge. Women in technical studies had the lowest resilience; women in medical sciences showed higher resilience; overall differences were observed in QoL domains depending on the study field. Observational, cross-sectional study (online survey) 471 Online survey measuring e-learning satisfaction, QoL, sociality, stress, and coping strategies. Associations between satisfaction and demographic/ psychological factors (age, stress, coping, social presence). Mean satisfaction score 30.6; stress score 19.4; students reported psychological and physical suffering 14 days/month. E-learning satisfaction is positively linked with age, course attendance, social presence, and coping (self-blame, religion) and negatively with stress/unhealthy days. Observational, cross-sectional study (online survey) 1842 Online survey measuring mental health-related QoL (SF-36), depression, anxiety, and lifestyle factors (e.g., smoking, alcohol, physical activity). Gender-specific analyses of associations between lifestyle factors and mental health indicators. Students had lower mental HRQoL than German/ American norms; women reported worse mental health than men. Negative associations: female gender, younger age, underweight, smoking, drug use. Positive associations: moderate alcohol consumption (females), physical activity (males). Observational, cross-sectional study (online survey) 887 Measurement of physical activity, sitting time, empathy (cognitive and affective), and perceived social support before and after easing campus restrictions. During campus access restrictions vs. after easing restrictions. Physical activity (moderate, vigorous, and total) increased after easing restrictions; walking was unchanged. Female students reported higher cognitive empathy after easing restrictions. Increases in physical activity correlate positively with affective empathy and family support. Observational, cross-sectional study (online survey) 433 Standardized self-report scales measuring anxiety, depression, stress, psychological well-being, academic satisfaction, and COVID-19–related stress on learning experience. Associations between academic satisfaction vs. COVID-19 stress on learning and mental health indicators. Academic satisfaction was a stronger predictor of mental health than COVID-19 stress. Low satisfaction was linked to higher stress, depression, and anxiety; high satisfaction was linked to better psychological well-being. The female gender is associated with more anxiety and stress. Observational, cross-sectional study (online survey) 353 Online survey assessing e-learning experience, screen exposure time, and self-reported headaches. Associations between screen exposure duration and headache prevalence/severity. 65.72% prevalence of headaches; 52.69% high screen exposure time. Increased screen time is significantly linked to higher headache and migraine reporting. Students were moderately satisfied with online learning but reported communication challenges; they preferred blended learning. Observational, cross-sectional study (online survey) Asipova N et al.: Impact of COVID-19 on health-related quality of life6 Population Intervention Comparison Outcomes Study design 1279 Online questionnaire including the Pittsburgh Sleep Quality Index, Insomnia Severity Index, SF-12 Health Survey, and Perceived Stress Scale. Students with poor sleep quality/insomnia vs. those with good sleep quality. 65% had poor sleep quality; 55% had insomnia symptoms. Poor sleep and insomnia are associated with higher stress and lower physical and mental HRQoL. Regression analysis confirmed sleep quality significantly predicted HRQoL. Observational, cross-sectional study (online survey) 703 Online survey measuring sociodemographics, physical activity, burnout syndrome, quality of life (QoL), and perceptions of online learning. Cluster analysis identifying different student profiles (low QoL, intermediate QoL, better QoL). Low QoL group: younger, mainly female, higher prevalence of psychological disorders, higher burnout, worse QoL, poorer online learning perception. Intermediate QoL group: older, more men, married/with children, better online learning perception. Better QoL group: higher QoL, lower burnout, more physical activity, better online learning perception. Cross-sectional cluster analysis 151 Online survey with multiple standardized tests: SF-36 Health Survey, State-Trait Anxiety Inventory, Beck Depression Inventory, Perceived Stress Scale, Loneliness Scale, Sleep Quality Rating, and Acceptance and Action Questionnaire. Male vs. female students on psychological stress, health-related quality of life, and mental health indicators. Female students reported worse general health perception, QoL, higher depression, anxiety, stress, loneliness, poorer sleep quality, and more psychological inflexibility compared to males. Observational, cross-sectional study (online survey) 56 Measurements of physical activity, sitting time, adherence to the Mediterranean diet, and body composition. Associations between lifestyle factors (activity, diet, sedentary time) and HRQoL. 19.64% spent >10 hours/day sitting; mean sitting time was 8.26 hours. 92.86% met WHO 2020 physical activity recommendations. 51.8% showed low adherence to the Mediterranean diet. 39.2% and 46.4% scored in the lowest quintile for physical and mental HRQoL, respectively. Negative correlation between physical function and sitting time (r = –0.38). Observational, cross-sectional study N/A * Rapid systematic review of psychological impact of COVID-19 on students. Observational study assessing affinity for e-learning and its effect on students’ well-being. Mental health outcomes in relation to students’ affinity for e-learning adoption. Pandemic and lockdown were associated with stress, anxiety, depression, distress, and reduced well-being. Affinity for e-learning acted as a buffer, positively influencing students’ resilience and mental health during COVID-19. Observational, systematic review 1000 Online survey assessing mental health (anxiety, depression, suicidal ideation, sleep, QoL, attitudes toward conspiracy theories). Mental health status before vs. during the COVID-19 lockdown (self-reported changes). Anxiety increased by 42.5%, depression by 74.3%, and suicidal thoughts by 63.3%. Sleep quantity increased for 66.3%, but quality worsened for 43%. QoL worsened for 57%. Clinical cases of depression increased 2.5–3-fold; suicidal thoughts increased ~8fold. About 30% accepted, and about 20% were open to conspiracy theories. Observational, cross-sectional study * does not contain information on the number of participants. Again in the USA, an observational study was conducted on perceived social support and the impact of COVID-19 on the quality of life of 1,296 students from a large public university in the Midwest (Cahuas et al. 2023). The study was conducted using two questionnaires: the Multidimensional Scale of Perceived Social Support and the COVID-19 Impact on Quality of Life scale. The results showed that perceived social support from family was an important predictor of quality of life for the entire group. Significant differences were found between men and women in terms of perceived social support, as well as quality of life during COVID-19. The group with a better quality of life had higher scores on perceived social support than the group with a low quality of life. The conclusion was that social support from family may act as a key buffer for quality of life during the COVID-19 pandemic among college students. Due to the limitation of social interactions during the COVID-19 pandemic, maintaining access to social support was extremely important. In 2020, an online survey was conducted in France: “Self-reported mental health symptoms, quality of life and coping strategies in French health science students during the early stage of the COVID-19 pandemic” (Leaune et al. 2020). An online questionnaire containing 128 items was Table 2. Distribution of included studies by year of publication. Year Counts % of total Cumulative % 2020 2 11.8% 11.8% 2021 2 11.8% 23.5% 2022 12 70.6% 94.1% 2023 1 5.9% 100.0% Pharmacia 72: 1–12 7 sent to 17,673 health science students at the Claude Bernard University Lyon in April 2020. It assessed sociodemographic characteristics, lockdown conditions, depressive, anxiety, and trauma symptoms, health-related quality of life, and coping strategies. The questionnaires were completed by 1,765 students. Their mental health-related quality of life scores were significantly worse than their physical health. Factors associated with worse mental health were female gender, COVID-19-like symptoms, social isolation, pandemic-related financial constraints, and exam stress. French health science students showed high levels of mental health problems and poor mental health-related quality of life during the early stage of the COVID-19 pandemic. Bernat et al. investigated the impact of landscape and the importance of recreational areas for university students in Lublin during the pandemic. The aim of the study was to determine whether and to what extent the COVID-19 pandemic affected the importance of recreational areas and the perception of landscape among students – a social group that is increasingly experiencing mood disorders and is strongly affected by the lockdown. The study was conducted in two stages among 381 students (Bernat et al. 2022). It was found that the importance of recreational areas increased during the pandemic. The perception of landscape also changed, with nature, scenic views, and the therapeutic effect of landscapes being appreciated to a greater extent. The results of the study show the need to provide a variety of green spaces, improve their accessibility, create quiet areas, provide green mobility, and offer places for recreation. Another study identified the level and proportions of smartphone addiction and academic procrastination and measured quality of life by gender and stage of study among students in light of the COVID-19 pandemic (Albursan et al. 2020). The study included 556 Saudi university students aged 18 to 52 years. Measures of academic procrastination and quality of life were used in addition to the Italian Scale of Smartphone Addiction. A total of 37.4% of the sample were addicted to smartphone use, while 7.7% had a high level of procrastination in their university duties and 62.8% had an average level of procrastination. A statistically significant positive relationship was found between academic procrastination and smartphone addiction, a statistically significant negative relationship between smartphone addiction and quality of life, and a negative relationship between quality of life and academic procrastination. Assessment of the quality of life of Polish university students during the COVID-19 pandemic according to the WHO quality of life questionnaire was carried out by Trzcionka and collaborators. The study population consisted of 500 students from three Polish universities – the Medical University of Silesia, the Maritime University in Szczecin, and Adam Mickiewicz University, Poznań (Trzcionka et al. 2022). The study participants completed an online quality of life questionnaire (WHOQOL-BREF) created by the WHO. The obtained results showed differences in respondents’ reactions in two domains. The lowest resilience to critical situations was observed in women who studied at the technical university. Higher resilience values were observed in women studying medical sciences. In 2021, the study “E-Learning Satisfaction, Stress, Quality of Life, and Coping: A Cross-Sectional Study in Italian University Students a Year after the COVID-19 Pandemic Began” (Cofini et al. 2021) was conducted. The study was carried out online and included 471 students attending the University of L‘Aquila in Abruzzo from June to July 2021. The primary objective was to assess satisfaction with e-learning, measured by the E-learning Satisfaction Scale, and secondary outcomes studied its relationship with demographic factors, perceived quality of life, sociability, stress, and coping strategies using a hierarchical regression model. The results showed that students suffered from mental and physical discomfort for 14 days per month. Satisfaction with e-learning was significantly associated with age and course attendance. It was positively associated with social presence score and coping strategies and was inversely related to stress and unhealthy days. In conclusion, the authors believe that respondents were inclined to use e-learning despite the end of quarantine. Sociability, stress, quality of life, and coping strategies play an important role in students‘ satisfaction with e-learning. Spagert et al. conducted a gender-specific multivariable analysis of mental health indicators and their association with lifestyle in German students. The analyses were based on a data set collected through an online survey among 1,842 students at a German university of applied sciences in 2014 (Spagert et al. 2022). The indicators used were mental health-related quality of life (mental HRQoL), depression, and anxiety, which were analyzed in a gender-specific manner. The mean mental health-related Table 3. Distribution of the number of participants in the analyzed studies. Number of studies 16 * Population (P) Missing 1 Mean 857 Standard error mean 155 95% CI mean lower bound 526 95% CI mean upper bound 1187 Median 630 Mode 56.0 ** Sum 13704 Standard deviation 619 Minimum 56.0 Maximum 2031 Skewness 0.699 Standard error skewness 0.564 Kurtosis -0.698 Standard error kurtosis 1.09 Shapiro-Wilk W 0.911 Shapiro-Wilk p 0.120 * One of the studies did not contain information on the number of participants. Note. The CI of the mean assumes sample means follow a t-distribution with N – 1 degrees of freedom. ** More than one mode exists; only the first is reported. Asipova N et al.: Impact of COVID-19 on health-related quality of life8 quality of life of the students studied (46.68), as measured by the SF-36 questionnaire, was lower than the population norm in Germany (48.76) and America (51.34). A key finding was the differences in mental health indicators between male and female students. Women reported a worse mental health status than men. Contrary to popular belief, students had worse mental health than the general population even before the pandemic. Due to the additional mental stress caused by the pandemic, it can be assumed that mental health problems have increased even more. The authors concluded that universities should pay more attention to the mental health of their students. Students in Japan were completely restricted from accessing campuses during the COVID-19 pandemic, with only online learning taking place. Shima et al. evaluated the impact of campus closures on physical activity, empathy, and social support among students during the COVID-19 pandemic. The study measured 887 students’ physical activity levels, sitting time, cognitive and affective empathy, and perceived social support before and after the easing of campus access restrictions (Shima et al. 2022). The results showed that overall activity levels increased after the easing of campus access restrictions. Cognitive empathy scores significantly increased among female students after the easing of restrictions, while no increase was observed among male students. Furthermore, changes in physical activity were positively associated with changes in affective empathy scores and perceived family support. In addition, changes in affective empathy scores were positively associated with perceived social support from family, friends, and loved ones. The findings suggest that increasing levels of physical activity following the easing of campus access restrictions could lead to better quality of life for young people during the COVID-19 pandemic. Table 4. Distribution of included studies by country and year of publication. Country Year Total 2020 2021 2022 2023 Brazil Observed 0 0 1 0 1 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 8.3% 0.0% 5.9% France Observed 0 0 1 0 1 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 8.3% 0.0% 5.9% Germany Observed 0 0 1 0 1 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 8.3% 0.0% 5.9% Greece Observed 1 0 0 0 1 % within row 100.0% 0.0% 0.0% 0.0% 100.0% % within column 50.0% 0.0% 0.0% 0.0% 5.9% Italy Observed 0 1 2 0 3 % within row 0.0% 33.3% 66.7% 0.0% 100.0% % within column 0.0% 50.0% 16.7% 0.0% 17.6% Japan Observed 0 0 1 0 1 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 8.3% 0.0% 5.9% Poland Observed 0 0 2 0 2 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 16.7% 0.0% 11.8% Saudi Arabia Observed 0 0 2 0 2 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 16.7% 0.0% 11.8% Spain Observed 0 1 1 0 2 % within row 0.0% 50.0% 50.0% 0.0% 100.0% % within column 0.0% 50.0% 8.3% 0.0% 11.8% Switzerland Observed 0 0 1 0 1 % within row 0.0% 0.0% 100.0% 0.0% 100.0% % within column 0.0% 0.0% 8.3% 0.0% 5.9% USA Observed 1 0 0 1 2 % within row 50.0% 0.0% 0.0% 50.0% 100.0% % within column 50.0% 0.0% 0.0% 100.0% 11.8% Total Observed 2 2 12 1 17 % within row 11.8% 11.8% 70.6% 5.9% 100.0% % within column 100.0% 100.0% 100.0% 100.0% 100.0% Pharmacia 72: 1–12 9 The study “Psychological distress and well-being among students of health disciplines in Geneva, Switzerland: The importance of academic satisfaction in the context of academic year-end and COVID-19 stress on their learning experience” aimed to investigate the psychological health and academic satisfaction of students in the context of COVID-19 and year-end stress (Tran et al. 2022). Standardized scales for anxiety, depression, stress, psychological well-being, academic satisfaction, and an ad hoc scale for stress due to COVID-19 were used. The participants were 433 firstto third-year students in eight different health-related tracks. The study concluded that academic satisfaction played a more significant role than stress due to COVID-19 in the learning process. Educational institutions should pay attention to the main factors that can increase students’ academic satisfaction by ensuring that they have continuous and adequate learning experiences, as well as access to psychosocial services that help them cope with mental distress and improve their psychological well-being. Abou Hashish et al. conducted the study “The online learning experience and reported headaches associated with screen exposure time among Saudi health sciences students during the COVID-19 pandemic.” The study was conducted among a sample of 353 students. Questionnaires were used to collect data on online learning, screen time exposure, and reported headaches. The results showed that students were moderately satisfied with online learning. However, they faced many challenges that affected their communication effectiveness, and they preferred blended learning. The study found a high prevalence of headaches (65.72%) and long screen time among the studied students (52.69%). The conclusion drawn from the results is that headaches are a common health problem among health sciences students and can harm their academic performance and quality of life, especially in relation to online learning. Blended learning approaches can improve student learning and performance in health sciences courses (Abou Hashish et al. 2022). Carpi et al., in their study “Sleep Quality and Its Associations with Physical and Mental Health-Related Quality of Life among University Students: A Cross-Sectional Study,” investigated the prevalence of poor sleep quality and insomnia and examined the relationships between these outcomes, perceived stress, and health-related quality of life among Italian students. An anonymous questionnaire including the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Short Form-12 Health Survey, and Perceived Stress Scale was administered to a sample of 1,279 students attending one of the largest Italian universities. In total, 65% of the participants showed poor sleep quality, and 55% reported symptoms of insomnia. Students reporting poor sleep quality and insomnia had higher scores on perceived stress and lower scores on physical and mental health-related quality of life. The relationship between sleep problems and quality of life is well documented, and the COVID-19 pandemic appears to have had an impact on both sleep quality and HRQoL. The study findings confirm the importance of sleep for college students’ well-being and may inform the development of health promotion interventions for this population (Carpi et al. 2022). “Quality of life, physical activity, and burnout syndrome during the online learning period in Brazilian university students during the COVID-19 pandemic: a cluster analysis” is a study conducted by Azzi et al. (Azzi et al. 2022) among Brazilian students, examining sociodemographic data, frequency of physical activity, areas of study, burnout syndrome, quality of life, and perception of online learning during the COVID-19 pandemic. Seven hundred and three students (aged 17 to 62, from 67 higher education institutions) participated in the study. Three different profiles of students were identified in terms of psychological aspects and perception of online learning. The first profile, called the “Low Quality of Life” group, consisted of younger students, mostly women, with a higher frequency of psychological disorders, in addition to higher burnout scores, lower quality of life, and worse perception of online learning. The second profile, called “Intermediate Quality of Life,” included participants with an average age of 45 years, with a higher number of men who were married, had children, and were working in addition to studying, and who had better scores for the perception of online learning than the “Low Quality of Life” group. The third profile, called “Better Quality of Life,” included students with higher scores in all areas of quality of life and a better perception of online learning, with a higher frequency of physical activity and lower scores for burnout syndrome. Medical students showed higher scores for overall quality of life. Students from exact sciences courses showed higher scores on all elements of the perception of online learning compared to students from other courses. The results of the survey provide insight into the mental health profile of students, allowing educational managers to outline specific coping strategies to help students during the pandemic. Bermejo-Franco and her team investigated gender differences in psychological stress factors among physical therapy students during the COVID-19 pandemic. The aim of the study was to investigate how the COVID-19 pandemic affected the mental health and quality of life of male and female physical therapy students at the European University of Madrid. The study was conducted online and included a set of tests covering different domains: the 36item Short Form Health Survey, the Six-item state version of the State-Trait Anxiety Inventory, the Acceptance and Action Questionnaire, the Three Items Loneliness Scale, the Four-item version of the Perceived Stress Scale, the Beck Depression Inventory revised version, and the Sleep Quality Numeric Rating Scale. A total of 151 students were included in the study, of which 78 were female and 73 were male. Gender differences were observed in most of the domains assessed. Female students showed worse levels of general health perception, quality of life, symptoms of depression, anxiety, stress, suppression of experiences and psychological inflexibility, sleep quality, and loneliness compared to male physical therapy students. The results of this study support the need for psychological inter-