As university students, we read with great interest the article by Aylie et al about the effect of the COVID-19 pandemic on university student mental health. The article highlighted that there has been an increase in depression, anxiety and stress levels and the need for governmental organisations to integrate psychological support into upcoming initiatives. 1 The study is very useful for understanding the impact of the pandemic. We would like to comment on areas of further consideration for this research. Stress was defined by the researchers as per the DASS-S criteria. Compared to the results from the DASS-D and DASS-A, this criterion has been found to be ineffective in other studies including amongst Vietnamese adolescents. 2 Furthermore, stress is a highly subjective experience that can be defined according to multiple parameters which the DASS-S alone may not account for. A study looking at the wellbeing of university students in the UK assessed similar parameters using five questionnaires which allowed for greater validity to their analysis. 3 Additionally, predominant variation in the outcome at different timepoints could have occurred because of the cross-sectional data used. Therefore, a longitudinal study would be a more effective measure. This is highlighted by research from the Mental Health foundation in the UK which demonstrated that the level of poor mental wellbeing was greater during the height of the pandemic (62% of the population had felt anxious or worried in the past two weeks), compared to a few months later at 49%. 4 Finally, although the author indicates that individuals with 'severe mental illness' were excluded, it would be useful to know the criteria for placing a person in to this category. Overall, providing greater insight into the mental health background of the participants would have been valuable to gain an accurate picture of the mental health effect of Covid-19. DisclosureThe authors report no conflicts of interest for this communication.
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