The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), also called COVID-19, arose in Wuhan, China, at the end of 2019, and poses a global health threat (1). The COVID-19 outbreak was spreading rapidly not only in China, but also worldwide, therefore, the World Health Organization (WHO) announced it as an outbreak of a new coronavirus disease on January 30, 2020, and a pandemic on March 12, 2020 (2). The epidemic of COVID-19 has been extensively affecting the living and life of individuals globally, more specifically after the statement of an international epidemic by the WHO (3).

The infectious disease of the COVID-19 pandemic affected all aspects of human life, including business, research, education, health, economy, sport, transportation, worship, social interactions, politics, governance, and entertainment in all populations, including patients, healthcare workers, the community, and students (4–6). Following its discovery, ongoing attempts are being made to put an end to the COVID-19 pandemic. In spite of several interventions, such as the distribution of different COVID-19 vaccinations in many nations, including Ethiopia, the majority of the populace refused to receive the shots. The COVID-19 pandemic causes the highest number of deaths and morbidity and has a huge economic, psychological, and social impact on the world (7, 8).

The pandemic has triggered a global health crisis and is a major public health emergency of international concern all over the world, which not only threatens the lives of people but also affects their mental health, such as major depressive disorder, fear, and stress (9).

In order to control the spread of the pandemic, many restricted local prevention policies, such as contact tracing and quarantine, staying home, lockdown, social and physical distance, and the closure of different facilities and services, had been taken, although they affected the normal lives of the people. Ethiopia has also implemented a number of prevention and control measures to stop the spread of COVID-19, including installing hand washing stations in public areas (such as banks, churches, mosques, and markets), setting up isolation facilities, and declaring a state of emergency across the country. Patients with proven or suspected COVID-19, medical staff, and even the general public were under a great deal of stress due to the COVID-19 pandemic’s rapid escalation and global spread, which was unresponsive to measures implemented and increased the risk of mental health issues (10).

For mental health services, this unprecedented catastrophe poses major challenges (4, 11). Due to the severe contagiousness of the pandemic, inherent scientific uncertainty, and stringent quarantine, all of these factors unavoidably increase patients’ fear and stigma, which makes it harder for them to get the help they need for effective and efficient medical care and psychological crisis intervention (12).

The pandemic’s effects on mental health have different degrees of impact on all populations, but those who live in socially deprived areas and those who work in critical positions are disproportionately impacted (13). Due to worries about their capacity to perform academically and succeed, as well as other problems like future careers and college social life, college and university students are among those who have been most negatively impacted by the COVID-19 pandemic (14). Higher education students around the world report showed that higher levels of anxiety, depressive moods, poor self-esteem, psychosomatic disorders, drug abuse, and suicidality when a pandemic is not present in comparison to the general population (15–17). The study in Pakistan showed that of university students are considered a vulnerable populace, and particular interventions and preventions are required to protect and improve their mental health and quality of life during the epidemic globally (15).

During this pandemic period, having mental and psychological problems leads to poor self-care practices, appetite, sleep, immunity status, and compliance with the instructions given by the healthcare provider that exposed them to infectious a etiology (18).

Due to the pandemic, mental health consequences increased by 1,000% in the United States during the lockdown (19), and it had also huge burden in our country Ethiopia (16). The quick propagation of the virus, greater access to information, and greater case fatality rate of this illness all contribute to the rise in unpleasant psychological effects (20). In order to deal with the effects of the condition on their physical and mental health, students might require additional resources and services. The psychological effects of COVID-19 that were most frequently studied and reported were stress, anxiety, and depression (16). Despite the fact, that many prevention and control strategies were implemented to slow the course of the disorders in Ethiopia.

Numerous studies have been done on the effects of the COVID-19 pandemic on higher education students’ mental health (16), but no systematic reviews or meta-analyses have been carried out in Ethiopia. A systematic study and meta-analysis were conducted to evaluate the combined prevalence of the psychological effects of the COVID-19 pandemic and its related components among higher education students (HES).

For the COVID-19 pandemic’s psychological effects to be improved, it is crucial to understand the prevalence and associated factors among college students. It also directs the areas of concentration and intervention measures for educational institutions and policymakers to lessen the effects of any other pandemic. Because of this, the purpose of this study was to perform a systematic review and meta-analysis to examine the psychological effects of the COVID-19 pandemic and its associated factors among students in higher education.

This study evaluated the pooled prevalence and combined impact of factors related to the pandemic’s psychological effects on HES in Ethiopia. According to our findings, the pooled prevalence of depression, anxiety, and stress during the COVID-19 pandemic among higher education students in Ethiopia was 43.49%, 46.27%, and 31.43%, respectively. Recent studies have similarly shown that COVID-19 affects mental health outcomes such as anxiety, depression, and post-traumatic stress symptoms (24, 25).

Based on our pooled estimate anxiety is the most prevalent psychological disorder followed by depression. This finding was in line with study from Pakistan (15, 26). The pooled prevalence of Anxiety among higher education students in our finding was higher than study conducted in Chinese student 26% (95% CI, 21%–30%) (27), but in line with systematic review meta-analysis findings from Spain 28% (95% CI: 22%–34%) (28), Canada 32% (29), Iran 31.9% (95% CI: 27.5–36.7) (24), China among non-Chinese students 36% (95% CI, 26%–46%) (27). But lower in Bangladesh 87.7% (30) and Egypt 70.5% (31).

Depression is a common psychological state affecting many people from all age groups and key role in worsening the prognosis of chronic diseases (32, 33). The pooled prevalence of depression in Ethiopia was 43.49%, which is comparable to the reports from China 37% (95% CI, 32%–42%) (27), Canada 34% (29), Iran 33.7% (95% CI: 27.5–40.6) (24), and from global pooled report 34% (29). However, it was higher than another study conducted in china 26% (23.3, 28.5) (34), but lower than Bangladesh 82.4% (30).

The pooled prevalence of stress was comparable with findings from India 29.6% (95% CI: 24.3–35.4) (35), and China 23% (95% CI, 8–39) (27). However, it was lower than studies from Europe 62% (41, 79%) (36), and Brazilian 57.5% (37). The possible reason for the discrepancy might be due differences in strict quarantine, incidence rate, the effect of lockdown, the difference in literacy level, study sittings difference, and environmental factor.

Factors associated with depression included a relative having COVID-19, insomnia, medical illness, and residence, all of which had a significant effect on the expression of depression symptoms in higher education students. Our pooled effect shows that living in an urban area reduces the risk of depression by 37% among higher education students; this finding is supported by a global systematic and meta-analysis report (38), United States (4), and China (39). In addition, it is supported by study finding from Gondar, Ethiopia (40). In contrast to this finding, a study conducted in Bangladesh (30) showed that being urban residence was a risk factor for having depression among students. Having medical condition increased the chance of depression among HES by 3.2 times compared to not having one. The study was consistent with a conclusion corroborated by a thorough analysis of the COVID-19 pandemic’s effects on mental health among medical students (28). This study also supported by findings from China (34) and Brazil (37). This is because having a past medical history may make COVID-19 effects worse, and comorbidities make COVID-19 effects more severe and fatal.

Students who had a medical illness was 3.2 times higher risk of depression than those who had not a medical illness. The finding was supported by other studies regarding COVID-19 pandemic and mental health consequences (31, 41). This is due to the fact that having a previous history of medical illness may exacerbate the mental impacts of COVID-19, its severity, and fatality of the disease. When compared to the comparable group, students with insomnia and COVID-19 relative death/illness have depression risks that are 1.7 and 2.4 times higher, respectively. Factors such as residence, medical illness, and field of the study showed a significant effect on the development of anxiety and stress.

Having a medical illness is a significant factor that increase the risk for the psychological impacts of COVID-19 among HES, whereas students were from urban residences had reduce effect on the disease’s psychological impact as compared with the counterpart. This finding was consistent with findings from China (39), united states (42). Students from the non-health department (field of study) were 3.2 and 4 times risk for anxiety and stress as compared with the health field of study, respectively. This was consistent with a systematic review findings done based on data from countries including China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark (38). The reason might be due to the fact that medical students exhibit high levels of resilience, which favorably correlate with effective problem-solving techniques or adaptive coping strategies when facing a problem (43–45).

The pooled proportion of psychological impact from COVID-19 among higher education students in Ethiopia was high. The most commonly reported psychological impacts were anxiety and depression. Insomnia, a medical condition, place of residence, and a family member contracting COVID-19 or passing away from it were all major predictors of depression. Non-health field of study, living with a parent, urban resident, and having medical illness were significant factors for anxiety. Living with parents and having a medical condition are significant predictors of the stress psychological effects of COVID-19. The results can be used to quantify the support requirements of students and to inform tiered and customized pandemic interventions that increase resilience and reduce vulnerability. This contributes to improving motivation for quick action. Therefore, it is crucial to provide psychological therapy, establish coping mechanisms, and address other issues in order to minimize the COVID-19 pandemic’s negative effects on mental health. Disease infectivity and fatality rates are also continuing to rise across the nation.

Governmental and private organizations and healthcare providers also provide psychosocial and mental health services alongside healthcare services and various media channels, front line health workers, social media platforms, email, and electronic letters to promote psychological support. Moreover, the government should incorporate mental health and psychological intervention within any outbreak prevention and mitigation program.

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

RA contributed to study conception and design, data analysis, interpretation, and manuscript drafting. AD, MA, and TA were involved in, literature searching data analysis, manuscript preparation, tables and figures, and critical revision. BM, SF, DA, and AM contributed to the literature search, data analysis, interpretation, and manuscript writing. BM had significant contributed on this manuscript starting from conceptualization, till literature searching, date extraction, analysis & interpretation, manuscript preparation, and revision of the manuscript. All authors were involved in reviewing the final draft of the manuscript, revision of the manuscript, and approved the submitted version.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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