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Our research group recently reported that symptom levels of depression, anxiety, and stress among Swedish university students were relatively stable during the first three months of COVID-19 and decreased slightly during the following three summer months. Since then, Sweden has faced a second and third wave of COVID-19. Aims: This study aims to describe the mean trajectories of depression, anxiety and stress symptoms among Swedish university students before and during the second and third waves of the COVID-19 pandemic. Methods: We recruited 1835 participants in September 2020, of whom 81% provided follow-ups in December 2020–January 2021 and 77% provided follow-ups in March–April 2021. The short-form Depression, Anxiety and Stress Scale was used to measure mental health symptoms. Generalized estimating equations were used to estimate the mean differences in symptom levels over the three time periods. Results: Compared with September, mean depression was 0.91 points of 21 higher (95% confidence interval (CI) 0.70–1.13) in December 2020–January 2021 and 0.66 points higher (95% CI 0.43–.88) in March–April 2021. Anxiety levels were 0.20 points higher (95% CI 0.05–0.34) in December 2020–January 2021 and 0.17 points higher (95% CI 0.02–0.33) in March–April 2021. Stress levels were 0.21 points higher (95% CI 0.00–0.41) in December 2020–January 2021 and 0.16 points lower (95% CI −0.38 to 0.05) in March–April 2021. Conclusions: Our results indicate relatively stable levels of mental health among Swedish university students during the second and third waves of COVID-19 compared with before the second wave. Mean depression symptom scores increased slightly, but the importance of this small increase is uncertain. [ABSTRACT FROM AUTHOR]

Aims: The COVID-19 pandemic has had a profound effect on societies and citizens worldwide, raising concerns about potential mental health impacts. We aimed to describe trajectories of depression, anxiety and stress symptoms during the COVID-19 outbreak compared to before the outbreak, and to determine if trajectories were modified by pre-pandemic loneliness, poor sleep quality and mental health problems. Methods: We conducted a cohort study with 1836 Swedish university students entering the study before 13 March 2020, the onset of the pandemic, with follow-ups within three (FU1) and six months (FU2) of the outbreak. Generalized Estimating Equations were used to estimate mean differences in symptom levels over time-periods, and to estimate potential effect modifications. Results: We found small differences in mean levels of the depression, anxiety and stress scale (DASS-21) over time. Compared to before the pandemic, depression increased by 0.25 points of 21 (95% CI: 0.04 to 0.45) at FU1 and decreased by 0.75/21 (95% CI:−0.97 to −0.53) at FU2. Anxiety decreased from baseline to FU1 by 0.09/21 (95% CI: −0.24 to 0.07) and by 0.77/21 (95% CI: −0.93 to −0.61) to FU2. Stress decreased from baseline to FU1 by 0.30/21 (95% CI: −0.52 to −0.09) and by 1.32/21 (95% CI: −1.55 to −1.09) to FU2. Students with pre-pandemic loneliness, poor sleep quality or pre-pandemic mental health problems did not have worse trajectories of mean mental health symptoms. Conclusions: Symptom levels were relatively stable during the first three months of the pandemic, while there was a slight decrease during the summer months, probably due to seasonality effects. [ABSTRACT FROM AUTHOR]