Introduction
The coronavirus disease 2019 (COVID-19 or COVID) pandemic significantly disrupted global mental health and social interactions, altering daily routines, educational systems, and personal relationships. Lockdowns, social distancing, financial instability, health concerns, and the shift to online learning contributed to heightened anxiety, depression, and stress (Pfefferbaum & North, 2020; Salari et al., 2020; Xiong et al., 2020). Although some recovery occurred, improvements have been uneven, particularly among students and healthcare professionals who continued to face academic and work-related pressures (Chutiyami et al., 2021; Loades et al., 2020). Social functioning—the ability to maintain interpersonal relationships—was similarly impacted, with distancing and remote environments leading to reduced engagement and greater isolation (Killgore et al., 2020). Health science students, including pharmacy students, were particularly affected due to the disruption of hands-on training and peer collaboration essential to their education (Son et al., 2020).
Gender and age differences further shaped outcomes. Women reported higher levels of stress and depression, linked to caregiving demands and societal expectations (Wenham et al., 2020; Zamarro & Prados, 2021), while men faced greater challenges in social functioning, likely influenced by traditional masculine norms that discourage emotional expression (Fitzpatrick et al., 2020; Mahalik et al., 2022). Younger adults, typically reliant on expansive social networks, experienced greater mental health difficulties than older adults, whose emotionally stable relationships helped buffer psychological distress (Carstensen et al., 2020; Loades et al., 2020; Luchetti et al., 2020). Overall, mental health and social functioning appeared interdependent, with disruptions in one area exacerbating challenges in the other (Meo et al., 2020).
Despite growing evidence, few studies have evaluated mental health and social functioning among pharmacy students during and after COVID-19. Existing research has often emphasized psychological symptoms (Carrion et al., 2023; Frajerman et al., 2022; Hammoudi Halat et al., 2022; Nakhostin-Ansari et al., 2022) or coping and resilience (Almhdawi et al., 2021; Fuentes et al., 2021) without incorporating validated multidimensional tools such as the SF-36 Health Survey or examining demographic moderators. Moreover, few studies have connected pandemic-related disruptions to the realities of hybrid education models, which are becoming common in PharmD programs today. This connection is critical because the hybrid structure of contemporary PharmD education—combining remote lectures, asynchronous learning, and limited in-person clinical experiences—mirrors several disruptions that students faced during the COVID-19 pandemic. These hybrid models, while offering flexibility, may inadvertently perpetuate reduced social connectedness and heightened mental health vulnerabilities similar to those observed during COVID-related remote learning. Thus, understanding how COVID-19 affected students’ mental health and social functioning provides valuable insights for shaping interventions that remain relevant in the evolving educational landscape.
To address these gaps, the current study aims to compare the mental health and social functioning of third-year PharmD students during the COVID and post-COVID periods using the SF-36v2® Health Survey. Secondary objectives include (i) investigating the effects of gender and age on mental health and social functioning, and (ii) examining how social functioning impacted mental health during the COVID period. The findings will contribute to the existing literature by providing a more comprehensive understanding of how COVID-19 affected the mental and social well-being of PharmD students, whose education heavily relies on in-person clinical training and collaboration. In addition, the study results will enhance the understanding of demographic factors influencing well-being during crises and contribute to the foundation for future efforts to strengthen mental health and social engagement in hybrid and evolving academic settings.
Methods
Study design and participants
This retrospective observational study evaluated the effects of COVID-19 on the mental and social well-being of a convenience sample of third-year PharmD students enrolled in the Pharmacoeconomics and Outcomes Science course from Spring 2020 to Spring 2024. The research utilized the Short Form 36v2 Health Survey (QualityMetrics, Inc.) to gather students’ perceptions of their health. As part of an assignment, students voluntarily completed the survey, providing valuable insights across key health domains. Mental health and social functioning outcomes were compared between the COVID (Spring 2020 to Spring 2022) and post-COVID (Spring 2023 to Spring 2024) periods. It was hypothesized that both health measures would be significantly higher and show improvement during the post-COVID period compared to the COVID period. All third-year students enrolled in the course were eligible to participate, with no additional inclusion or exclusion criteria applied.
Survey instrument
The SF-36v2® Health Survey is commonly used to evaluate health-related quality of life (HRQoL). This study incorporated four primary domains: the Mental Component Summary (MCS), which gauges mental health-related quality of life through subdomains such as emotional well-being, social interaction, and vitality; the Mental Health (MH) domain, which specifically assesses psychological well-being, including anxiety, depression, and emotional stability; Social Functioning (SF), which reviews how health influences interpersonal relationships and social engagement; and the Physical Component Summary (PCS), which aggregates information related to physical health (Ware & Sherbourne, 1992). While MCS and MH are interconnected, MCS provides a comprehensive view of mental health, while MH is a more targeted measure of emotional well-being.
Data collection and management
The Quality Metrics platform (https://www.amihealthy.com/) was used to administer the survey online. Students learned about the assignment during class and received a secure link to the survey. Demographic data (age and gender) were collected while ensuring anonymity by removing any personally identifiable information. After completing the survey, students obtained instant scores for their physical and mental health, which ranged from 20 to 80. The study received approval from the West Coast University Institutional Review Board, and data analysis was conducted in aggregate to preserve confidentiality.
Data analysis
Data were sourced from the Quality Metrics website in Excel format and subsequently imported into IBM SPSS Statistics® (version 29.0.2.0, IBM Corporation) for analysis. Descriptive statistics, independent samples t-tests (appropriate given the non-paired nature of the cohorts), and multiple regression analyses (to account for covariates) were conducted to examine differences in the dependent variables (i.e., MCS, MH, and SF) between the COVID and post-COVID periods. Given the secondary objective of focusing on the COVID period, additional analyses were performed to examine the effects of age and gender on the three primary dependent variables, as well as the effects of social functioning on mental health outcomes (MCS and MH). In the regression analyses, the predictors of interest included COVID status (coded as 0 = COVID period, 1 = post-COVID period), gender (coded as 1 = male, 0 = female), age (in years), and social functioning. PCS score was included as a covariate in all analyses to control for the influence of physical health on mental health and social functioning outcomes, which could otherwise confound the results. Prior to running the regression analyses, independent samples t-tests were conducted to provide an unadjusted comparison of each dependent variable across the predictor variables. A level of significance of 0.05 was used for the analyses. Given that all study hypotheses were directional, the two-sided p-values reported in the statistical output were divided by 2 for the one-sided significance tests.
Disclosure of generative artificial intelligence (AI) use
ChatGPT was used to generate ideas and refine language (OpenAI, 2025). In addition, Grammarly was employed to enhance sentence structure, ensure grammatical accuracy, and improve content clarity and readability (Grammarly, 2025). These tools were utilized strictly for support, with all intellectual contributions, data interpretation, and conclusions made by the authors.
Results
Data were collected from third-year PharmD students between Spring 2020 and Spring 2024. A total of 233 out of 294 students participated in the survey, resulting in a response rate of 79.3% (the usable response rate is 225/294 = 76.5%). Table 1 presents the demographic characteristics (age and gender) of students during the COVID and post-COVID periods. The proportion of students in the COVID period (n=132, 58.7%) was higher compared to those in the post-COVID period (n=93, 41.3%). Similarly, a higher proportion of both males (68.4%) and females (58.5%) participated during the COVID period compared to the post-COVID period (31.6% and 41.5%, respectively). PharmD students in the COVID period had a significantly higher age (29.71 vs. 28.34 years) compared to those in the post-COVID period (p=0.034); however, gender distribution did not vary significantly across the COVID and post-COVID groups (χ2=1.609, df=1, p=0.205).
The primary study results are presented in order based on the three main dependent variables examined (i.e., MCS, MH, and SF). Results for adjusted covariates in the multiple regression models (Table 3) are compared with unadjusted values from the independent samples t-tests (Table 2). Collinearity diagnostics indicated no issues with multicollinearity among the predictors for all multiple regression analyses.
Mental Component Summary (MCS)
Mental health (MCS scores) between COVID vs. post-COVID periods
Consistent with our one-sided hypothesis, results showed that PharmD students in the post-COVID period had significantly higher MCS scores compared to those in the COVID period. Results were consistent between the independent samples t-test (44.59 vs. 41.58, p=0.025, Table 2) and the multiple regression model that controlled for age, gender, SF, and PCS scores (p=0.035, Table 3).
COVID period only: effects of gender, age, and social functioning on mental health (MCS scores)
Consistent with our one-sided hypothesis, results indicated that male students had significantly higher MCS scores compared to female students. Findings were consistent between the independent samples t-test (45.21 vs. 40.46, p=0.022, Table 2) and the multiple regression model, which controlled for age, SF, and PCS scores (p=0.031, Table 3).
In addition, although older students had a higher MCS score compared to younger students, this difference was not statistically significant in both the independent samples t-test (43.20 vs. 41.54, p=0.251, Table 2) and the multiple regression analysis (p=0.050, Table 3). The regression analysis indicates that for each additional year of age, the average MCS score increases by 0.280 units while controlling for gender, SF, and PCS scores.
Furthermore, a multiple regression analysis indicates that higher social functioning is strongly associated with better MCS scores (p<0.0005, Table 3). This means that for each one-unit increase in SF score, the average MCS score increases by 0.958 units, while controlling for age, gender, and PCS scores.
Mental Health (MH)
Mental health (MH scores) between COVID vs. post-COVID periods
Results from an independent samples t-test showed that MH scores were higher post-COVID compared to during COVID, but this difference was not statistically significant (46.71 vs. 44.33, p=0.054, Table 2). However, MH scores were significantly higher post-COVID in a multiple regression analysis after controlling for age, gender, SF, and PCS scores (p=0.017, Table 3).
COVID period only: effects of gender, age, and social functioning on mental health (MH scores)
Results from the independent samples t-test showed that male students had a higher MH score compared to female students, but this difference was not statistically significant (46.84 vs. 43.44, p=0.067, Table 2). Similarly, the results from the multiple regression analysis were not significant despite controlling for age, SF, and PCS scores (p=0.198, Table 3).
In addition, while older students had a higher MH score compared to younger students, this difference was not statistically significant in both the independent samples t-test (45.06 vs. 44.33, p=0.379, Table 2) and the multiple regression analysis (p=0.057, Table 3). The regression analysis indicates that for each additional year of age, the average MH score increases by 0.345 units, controlling for gender, SF, and PCS scores.
Furthermore, a multiple regression analysis indicates that higher social functioning is strongly associated with better MH scores (p<0.0005, Table 3). This means that for a one-unit increase in SF score, the average MH score increases by 0.743 units, controlling for age, gender, and PCS scores.
Social Functioning (SF)
Social functioning between COVID vs. post-COVID periods
Consistent with our hypothesis, results from an independent samples t-test showed that SF scores were higher post-COVID compared to during the COVID period, although this increase was not statistically significant (46.29 vs. 44.20, p=0.067, Table 2). However, an opposite result was obtained from the multiple regression analysis after controlling for age, gender, MCS, and PCS scores. The regression analysis showed that SF scores were lower post-COVID compared to during the COVID period, though this decrease was also not statistically significant (p=0.158, Table 3).
COVID period only: effects of gender and age on social functioning
Consistent with our hypothesis, results from an independent samples t-test show that SF scores were higher among males compared to females, although this increase was not statistically significant (46.67 vs. 43.46, p=0.063, Table 2). However, a contradictory result was obtained from the multiple regression analysis after controlling for age, MCS, and PCS scores. The regression analysis indicated that SF scores were lower among males compared to females, although this decrease was not statistically significant (p=0.178, Table 3).
In addition, although older students had a lower SF score compared to younger students, this difference was not statistically significant in both the independent samples t-test (44.21 vs. 45.35, p=0.298, Table 2) and the multiple regression analysis (p=0.078, Table 3). The regression analysis shows that for each additional year of age, the average SF score decreases by 0.210 units, controlling for gender, MCS, and PCS scores.
Discussion
Mental health between COVID vs. post-COVID periods
The study revealed that both mental health scores (MCS and MH) were notably higher in the post-COVID period compared to during the pandemic. Research has repeatedly demonstrated that mental health issues, primarily anxiety and depression, escalated during the pandemic due to significant stressors such as social isolation, economic instability, and health-related fears affecting various groups (Pierce et al., 2020). Post-pandemic studies indicate a gradual recovery in mental health; however, levels have not fully returned to those observed before the pandemic, as ongoing economic and social repercussions persist (Fancourt et al., 2021). University students, including those in the PharmD program, were particularly susceptible to the mental health effects of the pandemic. Challenges with remote learning, academic interruptions, and uncertainties regarding future career paths contributed to increased stress and mental health concerns in this demographic (Son et al., 2020). The modest rise in MCS scores after COVID aligns with findings suggesting that as higher education institutions resumed in-person classes and eased pandemic-related restrictions, students began to experience a gradual recovery in their mental health (Kecojevic et al., 2020).
Gender and mental health
Supporting our hypothesis, the study revealed that males scored higher on MCS and MH metrics than females during COVID-19. Research indicates that women consistently report higher instances of anxiety and depression than men, both during the pandemic and before. This difference is often attributed to societal expectations, gender roles, and the added caregiving responsibilities women face during crises like COVID-19 (González-Sanguino et al., 2020). Women’s mental health has suffered more during this period, largely due to increased domestic responsibilities, job losses, and the stress of balancing family care with work obligations (Fisher et al., 2020). Although men generally report lower anxiety and depression levels, they tend to avoid seeking mental health help due to the stigma surrounding mental health for men. During COVID-19, some studies observed reduced levels of psychological distress among men; however, they are at a greater risk for severe mental health issues such as substance abuse and suicide (Thibaut & van Wijngaarden-Cremers, 2020).
Age and mental health
This study found that age had a minor, non-significant positive effect on MCS and MH scores, suggesting that older PharmD students experienced slightly better mental health outcomes compared to younger students during the COVID-19 pandemic. Research indicates that older adults often display greater emotional stability and psychological resilience than younger individuals, a phenomenon attributed to their life experience, coping strategies, and generally more optimistic emotional perspectives as they age. Studies during the pandemic revealed that older adults frequently reported fewer mental health challenges than their younger counterparts, who were more adversely affected by social isolation, educational disruptions, and job insecurity (Gubler et al., 2021; Losada-Baltar et al., 2021). Specifically, younger individuals, especially students, appeared more susceptible to the mental health challenges arising from COVID-19, reporting elevated rates of anxiety, depression, and stress due to sudden life changes and increased uncertainty regarding the future (Zhang & Ma, 2020).
Social functioning and mental health
This study indicated that higher social functioning scores were strongly associated with improved mental health outcomes (MCS and MH) throughout the COVID-19 pandemic. Social functioning, which describes a person’s capacity to initiate and sustain social connections, plays a crucial role in mental well-being (Fancourt et al., 2021). The pandemic-induced social isolation was often connected with adverse mental health effects, as lockdowns and distancing measures led to heightened anxiety, depression, and psychological distress (Brooks et al., 2020). In contrast, social functioning proved to be a protective element, with robust social support networks bolstering resilience against mental health issues. Engaging in social interactions offers emotional backing, alleviates feelings of loneliness, and promotes adaptive coping strategies, highlighting the significance of preserving relationships in times of crisis (Santini et al., 2020). People with lower social functioning face a higher risk of mental health issues, especially among students and older adults (Loades et al., 2020). Engaging socially helps cultivate a sense of belonging, identity, and psychological resilience, all of which are vital for mental wellness (Thoits, 2011). Moreover, social networks offer emotional support and shared experiences that are key to overall well-being (Fitzpatrick et al., 2020). These insights indicate that enhancing social engagement and creating supportive environments could be effective methods for boosting mental health.
Social functioning between COVID vs. post-COVID periods
The unadjusted analysis indicated that social functioning marginally improved after the pandemic compared to the COVID-19 period, suggesting a gradual recovery of interpersonal interactions as restrictions eased. The return to in-person interactions enabled individuals to reconstruct social networks disrupted by extended isolation and social distancing (Loades et al., 2020). Furthermore, reopening workplaces, schools, and social venues provided structured settings for social reintegration. Many people developed a renewed appreciation for their social relationships, leading to conscious efforts to reconnect with others (Pietrabissa & Simpson, 2020). The reduction of pandemic-related stressors, such as fear of infection and financial insecurity, also contributed to social recovery (Fancourt et al., 2021). Nonetheless, specific groups, particularly students and younger adults, may still face ongoing challenges in re-establishing their social networks due to interruptions during crucial developmental periods (Holt-Lunstad, 2022), underscoring the importance of continued support to enhance social connections and well-being.
Gender and social functioning
The unadjusted study results indicate that males scored higher on SF than females, suggesting a stronger social disruption experienced by women during COVID-19, even though this difference lacked statistical significance. Women’s increased responsibilities for caregiving, such as childcare and elder care, restricted their opportunities for social interaction (Craig & Churchill, 2021). In addition, elevated psychological distress, including anxiety and depression, further hindered their ability to maintain social networks (Xiong et al., 2020). Traditional gender roles may have intensified these differences, as women often prioritize caregiving needs over their social requirements (Wenham et al., 2020). In contrast, men maintained smaller, more structured networks typically associated with work, which were easier to sustain through virtual means (van der Velden et al., 2020). Women who rely more on in-person emotional support found virtual communication less satisfying (Lippke et al., 2021). These factors indicate that the pandemic exacerbated gender disparities in social engagement, significantly impacting women’s capacity to maintain social connections and networks.
Age and social functioning
This study found that age had a minor, non-significant negative effect on SF scores, suggesting that younger students exhibited slightly better social functioning than their older counterparts. However, this effect lacked statistical significance. Research has consistently shown that younger individuals generally maintain more active social lives and larger social networks compared to older adults. While younger adults often depend on friendships and peer interactions for social engagement, older adults usually have smaller, more intimate social circles. These variations may clarify why younger individuals exhibited somewhat superior social functioning during the COVID-19 period (Luchetti et al., 2020). Although younger individuals typically show better social functioning, they were disproportionately impacted by the pandemic restrictions due to their greater reliance on social interactions for emotional support. This dependence on in-person social networks, alongside the limitations imposed on social engagement during the pandemic, led to considerable mental health challenges for younger populations despite possessing stronger social networks on average (Loades et al., 2020).
Policy and healthcare implications
Given the strong association between social functioning and mental health, fostering opportunities for social connection is particularly crucial in hybrid academic environments. The flexible structure of hybrid PharmD programs—while providing academic convenience—may also restrict natural social interactions that typically occur in traditional face-to-face settings. Similar to experiences during COVID, this hybrid model can unintentionally increase feelings of isolation or hinder relationship-building, especially among students facing mental health challenges.
To support student well-being in these programs, targeted interventions could include structured peer support groups, virtual or in-person community-building activities, and mentorship programs that foster engagement across cohorts. These efforts can help recreate the sense of belonging that is often nurtured through in-person interactions (Brooks et al., 2020). Volunteering opportunities, student-led social clubs, and recreational or wellness events—available both online and on-campus—may further enhance social participation and reduce loneliness (Fancourt et al., 2021).
In addition, students who face challenges in maintaining interpersonal relationships may benefit from workshops focused on communication and relationship-building skills (Fitzpatrick et al., 2020). For those limited by geographic distance, caregiving responsibilities, or chronic health issues, technology-based interventions such as virtual support circles or moderated online communities can provide accessible and meaningful social engagement (Loades et al., 2020).
Mental health evaluations in academic settings should include assessments of social functioning to identify at-risk students and provide timely, customized support. Integrating social engagement strategies into wellness programming can enhance resilience, foster a supportive academic culture, and promote sustained mental health improvements, especially in partially remote educational settings (Fancourt et al., 2021; Santini et al., 2020).
Study limitations
This study has several limitations that should be considered when interpreting the results. First, the reliance on self-reported data from the SF-36 survey introduces potential biases, such as social desirability and inaccurate recall, which may affect the accuracy of the responses. In addition, the study’s cross-sectional design limits its ability to capture changes over time or establish causal relationships between variables. The sample, consisting solely of third-year PharmD students, is relatively homogeneous, which restricts the generalizability of the findings to other populations, such as students from different disciplines or non-student groups. The binary gender coding and age categorization also oversimplify diversity, excluding insights from non-binary or gender-diverse individuals and nuanced age effects.
Moreover, the context of the study, which is specific to the COVID-19 pandemic, limits the broader applicability of the findings to non-crisis periods. The lack of pre-pandemic data complicates the ability to attribute observed differences to the pandemic rather than to pre-existing conditions. Furthermore, unmeasured confounding factors, such as socioeconomic status, pre-existing mental health conditions, and access to technology, may have influenced the results. Incomplete data and the broad scope of the SF-36’s social functioning domain may also reduce the precision and robustness of the findings. Future studies might address these limitations by employing longitudinal designs, utilizing more diverse samples, and implementing more comprehensive measures of social functioning and mental health to enhance the understanding of these outcomes.
Conclusion
This study identified significant differences in mental health and social functioning between the COVID and post-COVID periods. Mental health outcomes (MCS) improved significantly following the lifting of restrictions, indicating recovery as daily routines and in-person interactions resumed. Although social functioning also improved post-COVID, the change was not statistically significant, suggesting only partial restoration of social networks. Younger adults and students may continue to face challenges related to extended periods of social isolation, highlighting the need for sustained mental health and social support programs in academic environments.
Gender disparities reflected global trends, with men reporting slightly better mental health and social functioning than women, although the differences were not statistically significant. Heightened caregiving responsibilities and reliance on in-person emotional support likely contributed to women’s increased vulnerability. These findings emphasize the importance of gender-sensitive mental health strategies. Age-related differences were modest; older students showed slightly better mental health, while younger students reported better social functioning. However, pandemic-related social disruption seemed to diminish traditional age-related patterns.
Importantly, the study confirmed a strong association between social functioning and mental health, reinforcing the protective role of social networks. Given that the hybrid educational models now common in PharmD programs reduce in-person engagement, similar challenges to those experienced during COVID-19 may persist. Therefore, future efforts must not only address academic performance but also prioritize rebuilding social connectedness within hybrid learning environments to safeguard student well-being.