{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T14:52:13Z","timestamp":1774623133617,"version":"3.50.1"},"reference-count":42,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Young adults, particularly university students might be at greater risk of developing psychological distress, and exhibiting symptoms of anxiety and depression during the COVID-19 pandemic. The primary objective of this study was to explore and compare the determinants and predictors of mental health (anxiety and depression) during and after the COVID-19 lockdown among university students.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an observational, cross-sectional study with a sample size of 417 students. An online survey utilizing International Physical Activity Questionnaire\u2013Short Form (IPAQ-SF), General Anxiety Disorder\u20137 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) was distributed to Universiti Tunku Abdul Rahman students via Google forms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During lockdown, family income [\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (1, n = 124) = 5.155, p = 0.023], and physical activity (PA) [\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (1, n = 134) = 6.366, p = 0.012] were associated with anxiety, while depression was associated with gender [\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      (1, n = 75) = 4.655, p = 0.031]. After lockdown, family income was associated with both anxiety [\u03c72 (1, n = 111) = 8.089, p = 0.004], and depression [\u03c72 (1, n = 115) = 9.305, p = 0.002]. During lockdown, family income (OR = 1.60, p = 0.018), and PA (OR = 0.59, p = 0.011) were predictors for anxiety, while gender (OR = 0.65, p = 0.046) was a predictor for depression. After lockdown, family income was a predictor for both anxiety (OR = 1.67, p = 0.011), and depression (OR = 1.70, p = 0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Significant negative effects attributed to the COVID-19 lockdown, and certain factors predisposed to the worsening of mental health status in university students. Low family income, PA, and female gender were the major determinants and predictors linked to anxiety and depression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0280562","type":"journal-article","created":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T13:27:11Z","timestamp":1674221231000},"page":"e0280562","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Determinants and predictors of mental health during and after COVID-19 lockdown among university students in Malaysia"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2409-9116","authenticated-orcid":true,"given":"Imtiyaz Ali","family":"Mir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6460-2789","authenticated-orcid":true,"given":"Shang Kuan","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Noh Zulfikri","family":"Mohd Jamali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed AbdulRazzaq","family":"Jabbar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syeda","family":"Humayra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"issue":"10223","key":"pone.0280562.ref001","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/S0140-6736(20)30211-7","article-title":"Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study","volume":"395","author":"N. 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Husky","year":"2020","journal-title":"Comprehensive Psychiatry"},{"issue":"June","key":"pone.0280562.ref008","doi-asserted-by":"crossref","first-page":"100357","DOI":"10.1016\/j.mhpa.2020.100357","article-title":"Mental health and movement behaviour during the COVID-19 pandemic in UK university students: Prospective cohort study","volume":"19","author":"M. J. Savage","year":"2020","journal-title":"Mental Health and Physical Activity"},{"issue":"1","key":"pone.0280562.ref009","doi-asserted-by":"crossref","first-page":"e0245327","DOI":"10.1371\/journal.pone.0245327","article-title":"Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States","volume":"16","author":"M. H. Browning","year":"2021","journal-title":"PloS one"},{"issue":"14","key":"pone.0280562.ref010","doi-asserted-by":"crossref","first-page":"8587","DOI":"10.3390\/ijerph19148587","article-title":"COVID-19 Aftermath: Exploring the Mental Health Emergency among Students at a Northern Italian University","volume":"19","author":"A. Patrono","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0280562.ref011","doi-asserted-by":"crossref","first-page":"e0277368","DOI":"10.1371\/journal.pone.0277368","article-title":"A cross-sectional study on the impact of the COVID-19 pandemic on psychological outcomes: Multiple indicators and multiple causes modeling","volume":"17","author":"M. A. Aljaberi","year":"2022","journal-title":"PLOS ONE"},{"issue":"COVID19-S4","key":"pone.0280562.ref012","first-page":"S43","article-title":"COVID-19 Pandemic: Impact of Quarantine on Medical Students\u2019 Mental Wellbeing and Learning Behaviors","volume":"36","author":"S. A. Meo","year":"2020","journal-title":"Pak J Med Sci"},{"key":"pone.0280562.ref013","first-page":"1","article-title":"College student mental health: Understanding changes in psychological symptoms in the context of the COVID-19 pandemic in the United States","author":"A. I. Roche","year":"2022","journal-title":"Curr Psychol"},{"issue":"3","key":"pone.0280562.ref014","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4103\/shb.shb_9_21","article-title":"Severe acute respiratory syndrome coronavirus-2-associated perceived stress and anxiety among indian medical students: A cross-sectional study","volume":"4","author":"R. Sharma","year":"2021","journal-title":"Asian Journal of Social Health and Behavior"},{"issue":"12","key":"pone.0280562.ref015","doi-asserted-by":"crossref","first-page":"e24487","DOI":"10.2196\/24487","article-title":"Anxiety and Suicidal Thoughts During the COVID-19 Pandemic: Cross-Country Comparative Study Among Indonesian, Taiwanese, and Thai University Students","volume":"22","author":"I. Pramukti","year":"2020","journal-title":"J Med Internet Res"},{"key":"pone.0280562.ref016","article-title":"A qualitative exploration of university students\u2019 perspectives on distance education in Jordan: An application of Moore\u2019s theory of transactional distance","volume":"7","author":"A. B. Al-Tammemi","year":"2022","journal-title":"Frontiers in Education"},{"issue":"8","key":"pone.0280562.ref017","doi-asserted-by":"crossref","DOI":"10.3390\/ejihpe12080079","article-title":"Exploring Factors Affecting Graduate Students\u2019 Satisfaction toward E-Learning in the Era of the COVID-19 Crisis","volume":"12","author":"L. A. Mohammed","year":"2022","journal-title":"European Journal of Investigation in Health, Psychology and Education"},{"key":"pone.0280562.ref018","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.copsyc.2021.09.014","article-title":"Contextualizing adolescent structural brain development: Environmental determinants and mental health outcomes","volume":"44","author":"L. Ferschmann","year":"2022","journal-title":"Current Opinion in Psychology"},{"issue":"2\u20133","key":"pone.0280562.ref019","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0165-0327(03)00195-2","article-title":"Diagnostic conversion from depression to bipolar disorders: results of a long-term prospective study of hospital admissions","volume":"84","author":"J. Angst","year":"2005","journal-title":"J Affect Disord"},{"issue":"11","key":"pone.0280562.ref020","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1007\/s00787-014-0614-z","article-title":"Brain changes in early-onset bipolar and unipolar depressive disorders: a systematic review in children and adolescents","volume":"23","author":"G. Serafini","year":"2014","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"pone.0280562.ref021","doi-asserted-by":"crossref","first-page":"111201","DOI":"10.1016\/j.pscychresns.2020.111201","article-title":"Differentiating bipolar disorder from unipolar depression in youth: A systematic literature review of neuroimaging research studies","volume":"307","author":"C. Kelberman","year":"2021","journal-title":"Psychiatry Research: Neuroimaging"},{"issue":"4","key":"pone.0280562.ref022","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1503\/jpn.170233","article-title":"Adolescent depression and brain development: evidence from voxel-based morphometry","volume":"44","author":"J. Straub","year":"2019","journal-title":"J Psychiatry Neurosci"},{"issue":"5","key":"pone.0280562.ref023","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1007\/s12035-020-02236-2","article-title":"Pathophysiological Clues to How the Emergent SARS-CoV-2 Can Potentially Increase the Susceptibility to Neurodegeneration","volume":"58","author":"M. Dolatshahi","year":"2021","journal-title":"Mol Neurobiol"},{"issue":"3","key":"pone.0280562.ref024","first-page":"735","article-title":"Mental Health Disorder among Malaysian Universities Students during COVID-19 Pandemic","volume":"18","author":"V. V. Kumaran","year":"2022","journal-title":"Asian Journal of University Education"},{"issue":"11","key":"pone.0280562.ref025","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2020.e05339","article-title":"Coping with COVID-19 and movement control order (MCO): experiences of university students in Malaysia","volume":"6","author":"K. Kamaludin","year":"2020","journal-title":"Heliyon"},{"key":"pone.0280562.ref026","first-page":"607","volume":"38","author":"R. V Krejcie","year":"1970","journal-title":"Determining sample size for research activities"},{"key":"pone.0280562.ref027","unstructured":"H. R. Rebecca, \u201cIncome classification in Malaysia: What is B40, M40, and T20,\u201d 2021. https:\/\/www.iproperty.com.my\/guides\/what-is-b40-m40-t20-in-malaysia\/"},{"key":"pone.0280562.ref028","unstructured":"H. L. Cheng, \u201cA simple, easy-to-use spreadsheet for automatic scoring of the International Physical Activity Questionaire (IPAQ) Short Form.\u201d 2016."},{"issue":"4","key":"pone.0280562.ref029","doi-asserted-by":"crossref","first-page":"300","DOI":"10.30773\/pi.2019.02.01","article-title":"Comparison of the Usefulness of the PHQ-8 and PHQ-9 for Screening for Major Depressive Disorder: Analysis of Psychiatric Outpatient Data","volume":"16","author":"C. Shin","year":"2019","journal-title":"Psychiatry Investig"},{"issue":"10","key":"pone.0280562.ref030","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"R. L. Spitzer","year":"2006","journal-title":"Archives of Internal Medicine"},{"issue":"2","key":"pone.0280562.ref031","doi-asserted-by":"crossref","first-page":"75","DOI":"10.4103\/shb.shb_38_22","article-title":"Comparison of the performance of machine learning-based algorithms for predicting depression and anxiety among University Students in Bangladesh: A result of the first wave of the COVID-19 pandemic","volume":"5","author":"M. H. Nayan","year":"2022","journal-title":"Asian J Soc Health Behav"},{"issue":"17","key":"pone.0280562.ref032","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/ijerph17176206","article-title":"Psychological impact of covid-19 and lockdown among university students in malaysia: Implications and policy recommendations","volume":"17","author":"S. Sundarasen","year":"2020","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"11","key":"pone.0280562.ref033","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18115811","article-title":"Physical activity as a predictor of the level of stress and quality of sleep during COVID-19 lockdown","volume":"18","author":"A. Lipert","year":"2021","journal-title":"International Journal of Environmental Research and Public Health"},{"issue":"18","key":"pone.0280562.ref034","first-page":"1","article-title":"Articles Association between physical exercise and mental health in 1 \u00b7 2 million individuals in the USA between 2011 and 2015: a cross-sectional study","volume":"0366","author":"S. R. Chekroud","year":"2018","journal-title":"The Lancet Psychiatry"},{"key":"pone.0280562.ref035","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2020.591797","article-title":"Fear of COVID-19, Stress, and Anxiety in University Undergraduate Students: A Predictive Model for Depression","volume":"11","author":"A. J. Rodr\u00edguez-Hidalgo","year":"2020","journal-title":"Frontiers in Psychology"},{"key":"pone.0280562.ref036","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5944\/rppc.28107","article-title":"Psychological impact of the COVID-19 pandemic: Negative and positive effects in Spanish population during the mandatory national quarantine","volume":"25","author":"B. Sandin","year":"2020","journal-title":"Revista de Psicopatolog\u00eda y Psicolog\u00eda Cl\u00ednica"},{"key":"pone.0280562.ref037","doi-asserted-by":"crossref","first-page":"112954","DOI":"10.1016\/j.psychres.2020.112954","article-title":"Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey","volume":"288","author":"Y. Huang","year":"2020","journal-title":"Psychiatry Research"},{"issue":"July","key":"pone.0280562.ref038","doi-asserted-by":"crossref","first-page":"113462","DOI":"10.1016\/j.psychres.2020.113462","article-title":"Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany","volume":"293","author":"C. Benke","year":"2020","journal-title":"Psychiatry Research"},{"issue":"1","key":"pone.0280562.ref039","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.genhosppsych.2010.11.001","article-title":"Is quarantine related to immediate negative psychological consequences during the 2009 H1N1 epidemic?","volume":"33","author":"Y. Wang","year":"2011","journal-title":"General Hospital Psychiatry"},{"issue":"December 2020","key":"pone.0280562.ref040","first-page":"69","volume":"134","author":"N. Meda","year":"2021","journal-title":"Students \u2018 mental health problems before, during, and after COVID-19 lockdown in Italy"},{"issue":"12","key":"pone.0280562.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pone.0244809","article-title":"Impact of COVID-19 pandemic on mental health: An international study","volume":"15","author":"A. T. Gloster","year":"2020","journal-title":"PLoS ONE"},{"issue":"3","key":"pone.0280562.ref042","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4103\/shb.shb_28_22","article-title":"Brief resilience interventions for mental health among college students: Randomized controlled trial","volume":"5","author":"S. 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