COVID-19 pandemic hit hard, and now what?

Investing in Green Care to Prevent Worsening Mental Health among University Students

Before the pandemic, the world population was already struggling with mental disorders, with depression and anxiety being leading contributors to the global burden of disease. COVID-19 exacerbated this and emphasized the urgent need to invest in support systems that can improve mental health.

According to a study conducted in 2020 across 204 countries, increased prevalence of major depressive disorder and anxiety disorders worldwide were associated with two COVID-19 impact indicators, namely daily SARS-CoV-2 infection rates and reductions in human mobility (Santomauro et al. 2021). These two indicators serve as a proxy for the combined effects of the pandemic, including virus spread, lockdowns, decreased public transport, closures of school and business, and overall decreased social interactions, among others. Globally, Santomauro et al. (2021) estimated an increase of 27.6% in cases of major depressive disorder (i.e. additional 53.2 million cases), and 25.6% in cases of anxiety disorders (i.e. additional 76.2 million cases) due to the COVID-19 pandemic.

Among the world population, women and younger age groups were the most affected by the pandemic (see Figure 1). More specifically, the additional prevalence of mental disorders was the highest among the population aged 20-24 years (i.e. 1,118 additional cases of major depressive disorder per 100,000 and 1,331 additional cases of anxiety disorders per 100,000). This article will focus on this young population, particularly university students who could greatly benefit from immediate solutions to prevent further mental health worsening.

Figure 1. Global prevalence and burden of depressive and anxiety disorders in 2020 due to the COVID-19 pandemic. Original source here. Full paper: Santomauro et al. 2021.

COVID-19 affects mental health of university students

UNESCO declared COVID-19 to be the most severe disruption to global education in history. School closures, restrictions, and virtual education meant students were unable to interact and learn in their normal settings. This dynamic has impaired mental health among students, which was a concern already prior to the COVID-19 outbreak. Pre-pandemic studies in the US estimated that roughly 20-30% of all undergraduate students experience a mental health problem (Ashwood et al. 2016). Another study conducted in large Australian universities (sample of 6,479 students), showed that the prevalence of mental health problems pre-pandemic was significantly higher than the general population, suggesting that university students were already a population at high risk of developing mental disorders (Stallman 2011).

The pandemic has put university students at greater risk (Chen and Lulock 2022). Increased mental health issues have negatively impacted academic performance, social interactions, and future opportunities, which in turn further reinforce mental health impairment. A study by Chen and Lulock (2022) conducted in North England during the first COVID-19 wave in 2020, found higher levels of anxiety and depression among university students, with more than 50% survey respondents (sample of 1,173 students) experiencing levels above the clinical threshold, and female students showing significantly higher levels than male students. Tuck et al. (2021) argue that student groups displaying the highest levels of distress due to COVID-19 are younger students, women, international students, and students that were already dealing with mental disorders.

Unsplash image by Tim Gouw

Mental wellbeing in universities based on Green Care

Despite global mental disorders are on the rise, a recent report by UNICEF (2021) highlights that only about 2% of government health budgets worldwide are allocated to mental health spending. This gap is also evident in higher education institutions where mental health funding and services are lagging behind the increasing rate of mental disorders. In the US, Ashwood et al. (2016) estimated that the social benefit of investing in prevention and early treatment would be of USD 6.49 for each dollar invested. This is because every dollar invested in prevention could represent savings in health-care costs and waste from non-completion of courses.

Resources exist to promote mental wellbeing, and in the wake of the COVID-19 pandemic taking no action is not an option. Promoting mental wellbeing through nature is gaining momentum worldwide and has the potential to be a cost-effective way to improve mental health among university students.

Spending time in nature speaks to several conditions identified as important to build resilience among students according to a new literature review conducted by Tuck et al. (2021), particularly because it provides the opportunity to focus attention on the present moment, engage in personally meaningful activities, and cultivate positive relationships.

Some universities have started to invest in programs that focus on promoting mental health building on nature-based solutions, yet these initiatives are still incipient. In 2019, some university campuses in the US came together to share their successes, failures, and innovative approaches for encouraging students to engage with nature. This exchange led to the formation of the Campus Nature Rx Network. In 2021, the network involved 24 US and Canadian institutions committed to conduct research and implement inclusive campus nature programs that support mental and physical health. For example, Cornell University launched a campus-wide initiative called Nature Rx @Cornell as a collaborative to promote the positive impact their campus nature has on the mental health of students. Their initiative involves (1) protecting and highlighting natural spaces on or near their campus, (2) organizing weekly walks and other events that motivate students to get out in nature, and (3) working with mental health providers in the clinical application of Nature Rx on campus.

Finally, supporting mental health by nature can also open an opportunity to restore nature’s health on campuses. The Nature Positive Universities network was recently launched by the United Nations Environment Program in collaboration with University of Oxford as a global network to promote nature restoration within higher education institutions. With many universities joining from different regions in the world (see Figure 2), this network has the potential to support greener mentality among students and future thinkers that can have a positive impact on the planet.

Figure 2. The Nature Positive Universities network. Interactive map available here.

Tahia Devisscher (University of British Columbia)


  • Ashwood, J.S., Stein, B.D., Briscombe, B., Sontag-Padilla, L., Woodbridge, M.W., May, E., Seelam, R. and Burnam, M.A., 2016. Payoffs for California college students and taxpayers from investing in student mental health. Rand Health Quarterly5(4).
  • Chen, T. and Lucock, M., 2022. The mental health of university students during the COVID-19 pandemic: An online survey in the UK. Plos one17(1), p.e0262562.
  • Tuck, D., Berger, E., Wiley, J.F., and Patlamazoglou, L. 2021. COVID has increased anxiety and depression rates among university students. And they were already higher than average. Available here.
  • Santomauro, D.F., Herrera, A.M.M., Shadid, J., Zheng, P., Ashbaugh, C., Pigott, D.M., Abbafati, C., Adolph, C., Amlag, J.O., Aravkin, A.Y. and Bang-Jensen, B.L., 2021. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. The Lancet398(10312), pp.1700-1712.
  • United Nations Children’s Fund (UNICEF). 2021. The State of the World’s Children 2021: On My Mind – Promoting, protecting and caring for children’s mental health. New York: UNICEF. Available here.
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