後疫情時代大學生自覺COVID-19威脅、運動行為與心理健康之關聯性

研究目的：本研究希望透過融合方法（mixed-methods），探討後疫情時代大學生自覺COVID-19威脅、運動行為與心理健康之關聯性。研究方法：採融合方法研究之解釋型序列設計。量性調查以班級為單位隨機抽樣，於2023年10月16日至2023年12月1日之間，使用SurveyCake建置結構式問卷，測量社會人口學、COVID-19疾病經驗、疫苗接種行為、防疫相關行為、自覺COVID-19威脅、中高強度運動行為、簡式健康量表，共1,048人納入分析。質性訪談以滾雪球抽樣招募研究對象，於2023年12月4日至2024年6月3日之間，使用訪談大綱進行個別深度訪談，共13人納入分析。量性調查以卡方檢定、Wilcoxon符號排序檢定、獨立樣本t檢定、相依樣本t檢定、變異數分析、皮爾森相關分析、多元線性迴歸、多分類邏輯斯迴歸等方法進行統計分析。質性訪談將訪談錄音檔轉譯為逐字稿，以紮根理論為基礎進行編碼分析。研究結果：(1) 控制疫情期間規律運動行為之後，自覺COVID-19易感受性、自覺COVID-19嚴重程度，未與後疫情時代運動行為顯著相關。(2) 後疫情時代運動行為之改變，分為COVID-19相關原因（感染風險、防疫措施）及其他原因（課業安排、課後活動、同儕關係）兩個面向。(3) 控制疫情期間心理健康之後，自覺COVID-19易感受性、自覺COVID-19嚴重程度、與疫情期間相比之後疫情時代運動行為改變情形，與後疫情時代心理健康顯著相關。(4) COVID-19對於大學生心理健康之影響，會因為學生身份別有所不同，外籍學生由於感染風險、死亡威脅、遠距教學、居家／宿舍、邊境管制等COVID-19事件，感受到擔心、壓力、孤單之負面情緒，本籍學生由於感染風險、確診經驗、遠距教學、居家／宿舍、疫苗接種、口罩佩戴等COVID-19事件，感受到擔心、焦慮、壓力、煩躁、難過之負面情緒，及放鬆、開心、自在之正面情緒。(5) 後疫情時代運動行為減少或部分維度減少者之後疫情時代心理健康較差。結論：與疫情期間相比，後疫情時代大學生之運動行為、心理健康沒有顯著改變，運動頻率、運動時間、運動強度則是於各維度各有增減。自覺COVID-19威脅與大學生後疫情時代運動行為沒有顯著關聯。後疫情時代運動行為之改變，受到感染風險、防疫措施、課業安排、課後活動、同儕關係影響。自覺COVID-19威脅與大學生後疫情時代心理健康具有顯著關聯。COVID-19對於大學生心理健康之影響，會因為學生身份別有所不同，COVID-19事件可能同時帶來正面或負面情緒影響。後疫情時代運動行為減少或部分維度減少者之後疫情時代心理健康較差。

Objective:The present study aims to investigate the correlation between perceived COVID-19 threat, exercise behavior and mental health among college students in the post-epidemic era with mixed-method approach.Methods:The present study adopted an explanatory sequential design of mixed methods research. For the quantitative survey, 1,048 college students who completed the structured questionnaire via SurveyCake from 16 October 2023 to 1 December 2023 were involved in the analysis. The structured questionnaire investigated socio-demographics, COVID-19 experience, vaccination behavior, preventive behavior, perceived COVID-19 threat, moderate to high intensity exercise behavior, and BSRS-5. For the qualitative interviews, 13 college students who completed the in-depth interviews individually from 4 December 2023 to 3 June 2024 were involved in the analysis. Chi-square test, Wilcoxon signed-rank test, independent samples t-test, dependent samples t-test, analysis of variance, Pearson correlation analysis, multivariate linear regression, and multinomial logistic regression were used to analyze quantitative data. Qualitative data were analyzed using grounded theory.Results:(1) Perceived COVID-19 susceptibility and perceived COVID-19 severity were not significantly associated with exercise behavior among college students in the post-epidemic era, after controlling for regular exercise behavior during the epidemic.(2) Changes in exercise behavior in the post-epidemic era were categorized into COVID-19-related reasons (risk of COVID-19 infection and preventive measures) and other reasons (course arrangement, extracurricular activities, and peer relationships).(3) Perceived COVID-19 susceptibility, perceived COVID-19 severity, and changes in exercise behavior in the post-epidemic era were significantly associated with mental health among college students in the post-epidemic era, after controlling for mental health during the epidemic.(4) The impact of COVID-19 on mental health varied by student status. Foreign students experienced negative emotions of worry, stress, and loneliness due to risk of COVID-19 infection, threat of death, distance learning, staying at home/dormitory, and border control. Native students experienced negative emotions of worry, anxiety, stress, irritability, and sadness, positive emotions of relaxation, happiness, and freedom due to risk of COVID-19 infection, confirmed experience, distance learning, staying at home/dormitory, COVID-19 vaccination, and wearing masks. (5) A decrease in exercise behavior was significantly associated with poorer mental health in the post-epidemic era. Conclusions:Compared with the epidemic period, there were no significant changes in exercise behavior and mental health among college students in the post-epidemic era, while the frequency, duration, and intensity of exercise increased or decreased in each dimension. Perceived COVID-19 threat was not significantly associated with college students’ exercise behavior in the post-epidemic era. Changes in exercise behavior in the post-epidemic era were influenced by risk of COVID-19 infection, preventive measures, course arrangement, extracurricular activities, and peer relationships. Perceived COVID-19 threat was significantly associated with college students’ mental health in the post-epidemic era. The impact of COVID-19 on college students’ mental health varied by student status, and COVID-19-related event can have both positive and negative emotional effects. A decrease in college students’ exercise behavior was significantly associated with poorer mental health in the post-epidemic era.