Factors Influencing COVID-19 Health Protective Behaviours in Zambian University Students with Symptoms of Low Mood

Background: Health protective behaviours are crucial in the prevention of the spread of COVID-19, particularly in university students who typically live and study in large groups. Depression and anxiety are common in students and can impact young people’s motivations to follow health advice. The study aims to assess the relationship between mental health and COVID-19 health-protective behaviours in Zambian university students with symptoms of low mood. Methods The study was a cross-sectional, online survey of Zambian university students. Invitation emails were sent explaining the study aims and directed students who self-identified as having low moods in the past two weeks to an online survey. Measures included COVID-19 preventive behaviours, COVID-19-related self-efficacy and Hospital and Anxiety Depression scale. Results A total of 620 students (n = 308 female, n = 306 male) participated in the study, with a mean participant age of 22.47 ± 3.29 years (range 18–51). Students reported a mean protective behaviour score of 74.09/105 and only 168 (27%) said they would accept vaccination against COVID-19, with male students being twice as likely to be willing to accept COVID-19 vaccination (p < 0.001). Over half the students (54%) scored above the threshold for depression and nearly three-quarters (74%) scored above the threshold for possible anxiety disorder. Three-way ANOVA showed lower COVID-19 protective behaviours in students scoring above the threshold for anxiety (p = .024) and those with low self-efficacy (p < 0.001). Gender was non-significant. Conclusion Students who self-identify as having symptoms of depression have high levels of anxiety. The results suggest that interventions to reduce anxiety and promote self-efficacy might enhance students’ COVID-19 protective behaviours. Further qualitative research is needed to understand the high rates of vaccine hesitancy in this population.